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General NPI Number Information
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NPI Number | 1699180505
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Entity Type | Individual
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Provider Name | DAVID BRACHO D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/30/2014
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 455 SAINT MICHAELS DR
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City | SANTA FE
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State | NM
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Zip | 87505-7601
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Country | US
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Telephone | 734-644-3516
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Fax |
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Provider Business Mailing Address
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Address Line | 455 SAINT MICHAELS DR
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City | SANTA FE
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State | NM
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Zip | 87505-7601
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Country | US
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Telephone | 734-644-3516
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | AP2282058A31
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | DO2023-0178
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 5101022104
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License Number State | MI
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