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NPI Code Detail

MEDICARE: HOLLY BRACKEN

MEDICARE: HOLLY BRACKEN
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
1106S00000XBehavior TechnicianBCAT #: 00002861NV

General Provider Information

NPI Number : 1518494228
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLY BRACKEN
Provider Business Mailing Address
First Line : 21600 OXNARD ST
Second Line : SUITE 1800
City : WOODLAND HILLS
State : CA
Zip : 91367-4976
Country : US
Telephone Number : 818-345-2345
Fax Number : 818-758-8015
Provider Business Practice Location Address
First Line : 74 N PECOS RD STE C
Second Line :
City : HENDERSON
State : NV
Zip : 89074-7344
Country : US
Telephone Number : 702-778-4500
Fax Number : 702-832-0244
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2017
Last Update Date : 05/12/2017

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Directions to “ HOLLY BRACKEN ” Practice Location

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