Provider Demographics
NPI:1396858338
Name:INES M BRACERAS MD PA
Entity Type:Organization
Organization Name:INES M BRACERAS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:INES
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:BRACERAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-444-6167
Mailing Address - Street 1:760 PONCE DE LEON BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2075
Mailing Address - Country:US
Mailing Address - Phone:305-444-6167
Mailing Address - Fax:305-444-4841
Practice Address - Street 1:760 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2075
Practice Address - Country:US
Practice Address - Phone:305-444-6167
Practice Address - Fax:305-444-4841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90901261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI15933Medicare UPIN
FLU32432Medicare ID - Type UnspecifiedMEDICARE PROVIDER #