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NPI Code Detail

MEDICARE: DIANNE BRAGANZA

MEDICARE:   DIANNE  BRAGANZA
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
1225100000XPhysical Therapist4826NM

General Provider Information

NPI Number : 1447789763
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANNE BRAGANZA
Provider Business Mailing Address
First Line : 3452 LAKE LYNDA DR STE 200
Second Line :
City : ORLANDO
State : FL
Zip : 32817-1481
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1607 7TH ST STE C
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701-4952
Country : US
Telephone Number : 505-454-1213
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2017
Last Update Date : 06/08/2017

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Directions to “ DIANNE BRAGANZA ” Practice Location

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