Healthcare Provider Details

I. General information

NPI: 1851568117
Provider Name (Legal Business Name): BRADEN JUSTIN CRISWELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2627 E WASHINGTON BLVD
PASADENA CA
91107-1412
US

IV. Provider business mailing address

2627 E WASHINGTON BLVD
PASADENA CA
91107-1412
US

V. Phone/Fax

Practice location:
  • Phone: 626-797-2002
  • Fax: 626-798-0567
Mailing address:
  • Phone: 626-797-2002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA123715
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberA123715
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: