MEDICARE: MARIO I. BRAKIN, M.D., F.A.A.P., INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0205X	Pediatric Endocrinology Physician	A33396	CA

General Provider Information

NPI Number	:	1164442620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIO I. BRAKIN, M.D., F.A.A.P., INC

Provider Business Mailing Address
First Line	:	2650 ELM AVE STE 318
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-1600
Country	:	US
Telephone Number	:	562-595-0166
Fax Number	:	562-595-6714

Provider Business Practice Location Address
First Line	:	2650 ELM AVE STE 318
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-1600
Country	:	US
Telephone Number	:	562-595-0166
Fax Number	:	562-595-6714

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARIO IGNACIO BRAKIN
Credential	:	M.D.
Telephone Number	:	562-595-0166

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	02/21/2023

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