Provider Demographics
NPI:1285680785
Name:PAVEL BRAUNSHTEIN
Entity Type:Organization
Organization Name:PAVEL BRAUNSHTEIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAVEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BRAUNSHTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-590-0433
Mailing Address - Street 1:6428 1/2 COLDWATER CANYON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-1113
Mailing Address - Country:US
Mailing Address - Phone:818-590-0433
Mailing Address - Fax:818-761-5968
Practice Address - Street 1:6428 1/2 COLDWATER CANYON AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-1113
Practice Address - Country:US
Practice Address - Phone:818-590-0433
Practice Address - Fax:818-761-5968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3901110001Medicare ID - Type Unspecified