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General NPI Number Information
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NPI Number | 1467072132
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Entity Type | Individual
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Provider Name | ADAM BRASKET NURSE PRACTITIONER
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Gender | Male
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Dates
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Enumeration Date | 04/22/2020
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Last Update Date | 09/24/2020
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Provider Practice Location Address
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Address Line | 5475 E LA PALMA AVE
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City | ANAHEIM
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State | CA
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Zip | 92807-2075
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Country | US
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Telephone | 949-333-5226
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Fax | 949-579-9102
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Provider Business Mailing Address
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Address Line | 11704 ETON DR
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City | GRAND TERRACE
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State | CA
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Zip | 92313-5125
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Country | US
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Telephone | 618-401-6468
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 743355
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95015268
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License Number State | CA
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