MEDICARE: DR. JURGEN BRAUNGARDT PH.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	103T00000X	Psychologist	MFT36477	CA

General Provider Information

NPI Number	:	1669504601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JURGEN BRAUNGARDT PH.D.

Provider Business Mailing Address
First Line	:	4344 MOUNTAIN VIEW AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94605-1208
Country	:	US
Telephone Number	:	510-482-4343
Fax Number	:	510-482-4344

Provider Business Practice Location Address
First Line	:	2220 MOUNTAIN BLVD
Second Line	:	SUITE 240
City	:	OAKLAND
State	:	CA
Zip	:	94611-2905
Country	:	US
Telephone Number	:	415-794-2003
Fax Number	:

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	07/08/2007

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