Provider Demographics
NPI:1043590912
Name:JACQUELINE BRACY, M.D., INC.
Entity Type:Organization
Organization Name:JACQUELINE BRACY, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRACY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-852-0411
Mailing Address - Street 1:PO BOX 1418
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-1418
Mailing Address - Country:US
Mailing Address - Phone:626-852-0411
Mailing Address - Fax:626-852-0407
Practice Address - Street 1:412 W CARROLL AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4240
Practice Address - Country:US
Practice Address - Phone:626-852-0411
Practice Address - Fax:626-852-0407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC043356207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty