Healthcare Provider Details

I. General information

NPI: 1164567491
Provider Name (Legal Business Name): MICHAEL ROBERT BRATTON SFIDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMDT CG-1122 U S COAST GUARD 2100 ST SW SUITE 5314
WASHINGTON DC
20593-0001
US

IV. Provider business mailing address

2680 WODEN ST
SAN DIEGO CA
92136-5491
US

V. Phone/Fax

Practice location:
  • Phone: 619-556-6530
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: