MEDICARE: AMANDA RAE BRATTEBO

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	237700000X	Hearing Instrument Specialist	HT10142	CA

General Provider Information

NPI Number	:	1669080834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA RAE BRATTEBO

Provider Business Mailing Address
First Line	:	1277 ENCINITAS BLVD
Second Line	:
City	:	ENCINITAS
State	:	CA
Zip	:	92024-2843
Country	:	US
Telephone Number	:	760-634-1469
Fax Number	:

Provider Business Practice Location Address
First Line	:	1277 ENCINITAS BLVD
Second Line	:
City	:	ENCINITAS
State	:	CA
Zip	:	92024-2843
Country	:	US
Telephone Number	:	760-818-9293
Fax Number	:

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

Provider Enumeration Date	:	07/14/2020
Last Update Date	:	07/14/2020

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Directions to “ AMANDA RAE BRATTEBO ” Practice Location

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