MEDICARE: MS. KARENKRISTINE ASUNCION BRAVO

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1568743763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KARENKRISTINE ASUNCION BRAVO

Provider Business Mailing Address
First Line	:	2633 DOLLAR ST
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-2119
Country	:	US
Telephone Number	:	714-204-5783
Fax Number	:

Provider Business Practice Location Address
First Line	:	2633 DOLLAR ST
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-2119
Country	:	US
Telephone Number	:	714-204-5783
Fax Number	:

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

Provider Enumeration Date	:	08/31/2011
Last Update Date	:	08/31/2011

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