Healthcare Provider Details

I. General information

NPI: 1396858338
Provider Name (Legal Business Name): INES M BRACERAS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 PONCE DE LEON BLVD
CORAL GABLES FL
33134-2075
US

IV. Provider business mailing address

760 PONCE DE LEON BLVD
CORAL GABLES FL
33134-2075
US

V. Phone/Fax

Practice location:
  • Phone: 305-444-6167
  • Fax: 305-444-4841
Mailing address:
  • Phone: 305-444-6167
  • Fax: 305-444-4841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberME90901
License Number StateFL

VIII. Authorized Official

Name: DR. INES MARIA BRACERAS
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 305-444-6167