Healthcare Provider Details

I. General information

NPI: 1417928862
Provider Name (Legal Business Name): BRASWELL MEDICAL CONSULTANTS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57333 JOSHUA LANE
YUCCA VALLEY CA
92284
US

IV. Provider business mailing address

57333 JOSHUA LANE
YUCCA VALLEY CA
92284-4247
US

V. Phone/Fax

Practice location:
  • Phone: 760-365-4870
  • Fax: 760-369-1407
Mailing address:
  • Phone: 760-365-4870
  • Fax: 760-369-1407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number240000320
License Number StateCA

VIII. Authorized Official

Name: JAMES HAROLD BRASWELL
Title or Position: PRESIDENT
Credential: NHA
Phone: 909-795-3821