Provider Demographics
NPI:1164442620
Name:MARIO I. BRAKIN, M.D., F.A.A.P., INC
Entity Type:Organization
Organization Name:MARIO I. BRAKIN, M.D., F.A.A.P., INC
Other - Org Name:PEDIATRIC ENDOCRINOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:IGNACIO
Authorized Official - Last Name:BRAKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-595-0166
Mailing Address - Street 1:2650 ELM AVE STE 318
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1600
Mailing Address - Country:US
Mailing Address - Phone:562-595-0166
Mailing Address - Fax:562-595-6714
Practice Address - Street 1:2650 ELM AVE STE 318
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1600
Practice Address - Country:US
Practice Address - Phone:562-595-0166
Practice Address - Fax:562-595-6714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA333962080P0205X, 2080P0205X
CAA852982080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0100650Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER