Provider Demographics
NPI:1235264235
Name:BRAUTBAR, NACHMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:NACHMAN
Middle Name:
Last Name:BRAUTBAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 S. WESTERN AVE
Mailing Address - Street 2:SUITE 505
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006
Mailing Address - Country:US
Mailing Address - Phone:323-634-6500
Mailing Address - Fax:323-634-6501
Practice Address - Street 1:1818 S. WESTERN AVE
Practice Address - Street 2:SUITE 505
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006
Practice Address - Country:US
Practice Address - Phone:323-634-6500
Practice Address - Fax:323-634-6501
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A30713207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA30713OtherCALIFORNIA MEDICAL BOARD STATE LICENSE