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General NPI Number Information
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NPI Number | 1215108808
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Entity Type | Organization
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Legal Business Name | IRA R. BRAVERMAN, M. D. INC.
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Dates
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Enumeration Date | 03/21/2008
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Last Update Date | 03/21/2008
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Provider Practice Location Address
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Address Line | 610 EUCLID AVE SUITE 201
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City | NATIONAL CITY
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State | CA
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Zip | 91950-2951
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Country | US
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Telephone | 619-267-8181
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Fax | 619-479-6750
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Provider Business Mailing Address
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Address Line | 610 EUCLID AVE SUITE 201
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City | NATIONAL CITY
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State | CA
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Zip | 91950-2951
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Country | US
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Telephone | 619-267-8181
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Fax | 619-479-6750
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IRA RICHARD BRAVERMAN
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Credential | M. D.
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Telephone | 619-267-8181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | A37912
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License Number State | CA
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