Provider Demographics
NPI:1356647614
Name:BRAZIEL, JEFF SCOTT (RN)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:SCOTT
Last Name:BRAZIEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 C ST STE 212
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-5121
Mailing Address - Country:US
Mailing Address - Phone:619-238-4180
Mailing Address - Fax:619-238-4245
Practice Address - Street 1:427 C ST STE 212
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-5121
Practice Address - Country:US
Practice Address - Phone:619-238-4180
Practice Address - Fax:619-238-4245
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA786725163W00000X
TN93492163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse