Healthcare Provider Details

I. General information

NPI: 1093477077
Provider Name (Legal Business Name): ALEXANDRA BEVERLY BRAUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRA MAYANN BEVERLY

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W 3RD ST STE 795W
LOS ANGELES CA
90048-6129
US

IV. Provider business mailing address

4140 W 190TH ST
TORRANCE CA
90504-5513
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-8350
  • Fax: 310-423-8351
Mailing address:
  • Phone: 310-423-8350
  • Fax: 310-423-8351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11015835
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11015835
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number11015835
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95031977
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: