Healthcare Provider Details

I. General information

NPI: 1114448263
Provider Name (Legal Business Name): MA DEL CARMEN VALDES BRACAMONTES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE
BROOKLYN NY
11203-2012
US

IV. Provider business mailing address

450 CLARKSON AVE
BROOKLYN NY
11203-2012
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-8867
  • Fax:
Mailing address:
  • Phone: 718-270-8867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number021100
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: