MEDICARE: MS. JANINE E. BRADY RN

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	163WC1500X	Community Health Registered Nurse	261923	CA

General Provider Information

NPI Number	:	1568583904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANINE E. BRADY RN

Provider Business Mailing Address
First Line	:	1055 LAGUNA DR
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008-1859
Country	:	US
Telephone Number	:	760-458-2058
Fax Number	:

Provider Business Practice Location Address
First Line	:	1305 UNION PLAZA CT
Second Line	:	STE. 200
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-5659
Country	:	US
Telephone Number	:	760-754-5951
Fax Number	:	760-754-4595

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/08/2007

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