Healthcare Provider Details

I. General information

NPI: 1215668249
Provider Name (Legal Business Name): SCOTT P BRAUSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 MADRID AVE
TORRANCE CA
90501-2533
US

IV. Provider business mailing address

1418 MADRID AVE
TORRANCE CA
90501-2533
US

V. Phone/Fax

Practice location:
  • Phone: 310-488-2799
  • Fax:
Mailing address:
  • Phone: 310-488-2799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: