MEDICARE: DR. MARIO IGNACIO BRAKIN MD

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	A-33396	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215921028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIO IGNACIO BRAKIN MD

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	02/20/2023

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