Provider Demographics
NPI:1497475057
Name:BRACEROS, KATHRYN KELANI S
Entity Type:Individual
Prefix:
First Name:KATHRYN KELANI
Middle Name:S
Last Name:BRACEROS
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 1:2024 W 184TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5422
Mailing Address - Country:US
Mailing Address - Phone:310-291-2003
Mailing Address - Fax:
Practice Address - Street 1:2024 W 184TH ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-5422
Practice Address - Country:US
Practice Address - Phone:310-291-2003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program