Healthcare Provider Details

I. General information

NPI: 1720246705
Provider Name (Legal Business Name): JEANIESAR BRAWNER CALUAG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 JULIANNA AVE
MOSS BEACH CA
94038-9648
US

IV. Provider business mailing address

31 JULIANNA AVE
MOSS BEACH CA
94038-9648
US

V. Phone/Fax

Practice location:
  • Phone: 415-615-2534
  • Fax:
Mailing address:
  • Phone: 415-615-2534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA108220
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: