Provider Demographics
NPI:1003109760
Name:BRAGINA, BRIGITTA VALERIA (LAC)
Entity Type:Individual
Prefix:
First Name:BRIGITTA
Middle Name:VALERIA
Last Name:BRAGINA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:BRIGITTA
Other - Middle Name:
Other - Last Name:MOSKOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:522 IVYSIDE SQ
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7761
Mailing Address - Country:US
Mailing Address - Phone:614-284-8017
Mailing Address - Fax:
Practice Address - Street 1:2511 OAKSTONE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-7612
Practice Address - Country:US
Practice Address - Phone:614-423-8368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH000187171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist