Healthcare Provider Details

I. General information

NPI: 1982809877
Provider Name (Legal Business Name): ELIZABETH ALEXIS BRAGG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH ALEXIS CHARNOVICH M.D.

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 07/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 SUNSET BLVD MS#3
LOS ANGELES CA
90027
US

IV. Provider business mailing address

1750 CAMINO PALMERO ST APT 440
LOS ANGELES CA
90046-2984
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-5591
  • Fax:
Mailing address:
  • Phone: 412-527-6610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD70758
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number134893
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: