MEDICARE: DR. LAWRENCE BRASLOW JR. M.D.

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	2084P0800X	Psychiatry Physician	A42773	CA

General Provider Information

NPI Number	:	1588794986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE BRASLOW JR. M.D.

Provider Business Mailing Address
First Line	:	1411 SILVIUS AVE
Second Line	:
City	:	SAN PEDRO
State	:	CA
Zip	:	90731-6039
Country	:	US
Telephone Number	:	310-831-1569
Fax Number	:

Provider Business Practice Location Address
First Line	:	6051 N FRESNO ST STE 201
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93710-5280
Country	:	US
Telephone Number	:	323-766-2360
Fax Number	:	323-766-2371

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	06/13/2019

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