=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639392244
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDITH SAPERSTEIN BRAUN MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7946 IVANHOE AVE #210
-----------------------------------------------------
City | LA JOLLA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-459-3601
-----------------------------------------------------
Fax | 619-542-8556
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1270 MYRTLE AVE
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-291-3788
-----------------------------------------------------
Fax | 619-842-8556
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | G26720
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------