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General NPI Number Information
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NPI Number | 1811090111
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Entity Type | Individual
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Provider Name | STEPHEN D BRAGIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | 1225 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90017-1901
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Country | US
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Telephone | 213-977-2000
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Fax | 213-977-2030
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Provider Business Mailing Address
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Address Line | PO BOX 3201
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City | GLENDALE
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State | CA
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Zip | 91221-0201
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Country | US
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Telephone | 213-977-2000
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Fax | 213-977-2030
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | G30255
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License Number State | CA
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