Provider Demographics
NPI:1154637205
Name:BRAGANCA, TREVOR JOHN (PHARM D)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:JOHN
Last Name:BRAGANCA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15630 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-3141
Mailing Address - Country:US
Mailing Address - Phone:818-783-2449
Mailing Address - Fax:
Practice Address - Street 1:15630 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-3141
Practice Address - Country:US
Practice Address - Phone:818-783-2449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63658183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist