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General NPI Number Information
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NPI Number | 1760723480
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Entity Type | Organization
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Legal Business Name | MARK B. BRAUNSTEIN, MD INC
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Dates
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Enumeration Date | 03/05/2013
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Last Update Date | 03/05/2013
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Provider Practice Location Address
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Address Line | 4849 VAN NUYS BLVD STE 105
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-2110
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Country | US
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Telephone | 818-905-9598
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Fax | 818-905-0130
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Provider Business Mailing Address
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Address Line | 4849 VAN NUYS BLVD STE 105
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-2110
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Country | US
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Telephone | 818-905-9598
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Fax | 818-905-0130
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Authorized Official
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Title or Position | MD, PRESIDENT
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Name | MARK B BRAUNSTEIN
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Credential | MD
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Telephone | 818-905-9598
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G64033
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License Number State | CA
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