Provider Demographics
NPI:1497861231
Name:BRASLAU, DANIEL LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:LAWRENCE
Last Name:BRASLAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 10609
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91510-0609
Mailing Address - Country:US
Mailing Address - Phone:818-526-0200
Mailing Address - Fax:818-526-0258
Practice Address - Street 1:665 MUNRAS AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940
Practice Address - Country:US
Practice Address - Phone:831-656-9800
Practice Address - Fax:831-656-9801
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG690372085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F82653Medicare UPIN