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NPI Code Detail

MEDICARE: LATREVA JANICE BRADEN

MEDICARE: LATREVA JANICE BRADEN
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
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1477750354
Entity Type Code : Individual
Provider Name (Legal Business Name) : LATREVA JANICE BRADEN
Provider Business Mailing Address
First Line : 9808 VENICE BLVD STE 700
Second Line :
City : CULVER CITY
State : CA
Zip : 90232-6824
Country : US
Telephone Number : 310-945-3350
Fax Number :
Provider Business Practice Location Address
First Line : 923 S CATALINA AVE
Second Line :
City : REDONDO BEACH
State : CA
Zip : 90277-4718
Country : US
Telephone Number : 310-945-3350
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2007
Last Update Date : 09/08/2023

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Directions to “ LATREVA JANICE BRADEN ” Practice Location

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