Provider Demographics
NPI:1083071484
Name:BRALOCK, ANITA RENAU (CNM)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:RENAU
Last Name:BRALOCK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
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Mailing Address - Street 1:4136 W 62ND ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-3613
Mailing Address - Country:US
Mailing Address - Phone:818-470-6321
Mailing Address - Fax:323-298-5352
Practice Address - Street 1:1080 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-2310
Practice Address - Country:US
Practice Address - Phone:323-957-3737
Practice Address - Fax:323-957-8777
Is Sole Proprietor?:No
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA1115367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife