Provider Demographics
NPI:1841752250
Name:BRAIMOH, JULISSA (MD)
Entity Type:Individual
Prefix:
First Name:JULISSA
Middle Name:
Last Name:BRAIMOH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULISSA
Other - Middle Name:
Other - Last Name:PLACENCIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2118
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70571-2118
Mailing Address - Country:US
Mailing Address - Phone:347-885-2975
Mailing Address - Fax:
Practice Address - Street 1:1270 ATTAKAPAS DR STE 102
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6549
Practice Address - Country:US
Practice Address - Phone:337-678-4862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036161456207Q00000X
LA338497207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine