Provider Demographics
NPI:1255491221
Name:BRAU, SALVADOR A (MD)
Entity Type:Individual
Prefix:DR
First Name:SALVADOR
Middle Name:A
Last Name:BRAU
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 1:1334 WESTWOOD BLVD
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4951
Mailing Address - Country:US
Mailing Address - Phone:310-470-9911
Mailing Address - Fax:310-470-2295
Practice Address - Street 1:1334 WESTWOOD BLVD
Practice Address - Street 2:SUITE 1D
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4951
Practice Address - Country:US
Practice Address - Phone:310-470-9911
Practice Address - Fax:310-470-2295
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG339642086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G339640Medicaid
CAWG33964CMedicare ID - Type UnspecifiedMEDICARE PROVIDER #
CAA45738Medicare UPIN