Provider Demographics
NPI:1548430580
Name:BRAZA, EDNA PASQUEL
Entity Type:Individual
Prefix:DR
First Name:EDNA
Middle Name:PASQUEL
Last Name:BRAZA
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 1:650 HOBSON WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-6706
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:650 HOBSON WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-6706
Practice Address - Country:US
Practice Address - Phone:805-240-7996
Practice Address - Fax:805-240-7935
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA432281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice