Provider Demographics
NPI:1689615437
Name:BRAUNSTEIN, JOHN BERNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BERNARD
Last Name:BRAUNSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5686
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-5686
Mailing Address - Country:US
Mailing Address - Phone:714-571-5000
Mailing Address - Fax:714-571-5055
Practice Address - Street 1:555 E HARDY ST
Practice Address - Street 2:CENTINELA HOSPITAL MEDICAL CENTER
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4011
Practice Address - Country:US
Practice Address - Phone:818-409-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG585942085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G585940OtherBLUE SHIELD
CA1689615437Medicaid
CAP01086188OtherRAILROAD MEDICARE
CACB206640Medicare PIN
CAWG58594JMedicare PIN
CA00G585940OtherBLUE SHIELD
CAWG58594DMedicare PIN
CA1689615437Medicaid
CAWG58594CMedicare PIN
CAE85684Medicare UPIN