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General NPI Number Information
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NPI Number | 1821469321
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Entity Type | Individual
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Provider Name | JACQUELINE BRAMBILA PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/09/2015
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Last Update Date | 01/27/2017
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Provider Practice Location Address
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Address Line | 1617 WESTCLIFF DR SUITE 207
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-5524
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Country | US
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Telephone | 949-515-4111
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Fax | 949-515-0318
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Provider Business Mailing Address
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Address Line | 8131 VANTAGE AVE
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91605-1438
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 52924
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License Number State | CA
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