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General NPI Number Information
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NPI Number | 1396806253
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Entity Type | Individual
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Provider Name | JACQUELINE BRACY M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 08/30/2016
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Provider Practice Location Address
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Address Line | 210 S GRAND AVE SUITE 324
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City | GLENDORA
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State | CA
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Zip | 91741-4205
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Country | US
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Telephone | 626-852-0411
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Fax | 626-852-0407
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Provider Business Mailing Address
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Address Line | PO BOX 1418 SUITE 324
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City | GLENDORA
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State | CA
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Zip | 91740-1418
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Country | US
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Telephone | 626-852-0411
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Fax | 626-852-0407
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | C043356
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License Number State | CA
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