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General NPI Number Information
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NPI Number | 1912693904
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Entity Type | Organization
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Legal Business Name | PATRICIO AND SANDRA BRACERO HAVEN, INC
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Dates
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Enumeration Date | 04/13/2023
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 15475 SENECA RD STE B
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City | VICTORVILLE
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State | CA
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Zip | 92392-2299
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Country | US
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Telephone | 702-493-7831
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Fax | 760-493-2875
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Provider Business Mailing Address
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Address Line | 15475 SENECA RD STE B
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City | VICTORVILLE
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State | CA
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Zip | 92392-2299
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Country | US
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Telephone | 702-493-7831
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Fax | 760-493-2875
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Authorized Official
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Title or Position | CEO
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Name | CAROL P MARTINEZ
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Credential |
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Telephone | 760-493-7831
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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