Provider Demographics
NPI:1417383787
Name:BRACAMONTE, KARINA ISELA
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:ISELA
Last Name:BRACAMONTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3921 HAMPTON GROVE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7922
Mailing Address - Country:US
Mailing Address - Phone:702-498-3865
Mailing Address - Fax:
Practice Address - Street 1:4424 LOMA CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-5204
Practice Address - Country:US
Practice Address - Phone:702-373-1651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker