Healthcare Provider Details

I. General information

NPI: 1326341116
Provider Name (Legal Business Name): ROBERTO L. BRAGLIA, MD. PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2010
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 BOOTY ST
CORPUS CHRISTI TX
78404-2104
US

IV. Provider business mailing address

714 BOOTY ST
CORPUS CHRISTI TX
78404-2104
US

V. Phone/Fax

Practice location:
  • Phone: 361-888-4444
  • Fax: 361-882-6918
Mailing address:
  • Phone: 361-888-4444
  • Fax: 361-882-6918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberF3687
License Number StateTX

VIII. Authorized Official

Name: DR. ROBERTO L, BRAGLIA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 361-888-4444