Healthcare Provider Details

I. General information

NPI: 1629986062
Provider Name (Legal Business Name): CLINTON BRAYAN PARRAGA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 PARK ST
NEW HAVEN CT
06519-1110
US

IV. Provider business mailing address

310 WILLOW ST APT 2L
NEW HAVEN CT
06511-2432
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-4242
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number232341
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: