Provider Demographics
NPI:1215108808
Name:IRA R. BRAVERMAN, M. D. INC.
Entity type:Organization
Organization Name:IRA R. BRAVERMAN, M. D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:BRAVERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:619-267-8181
Mailing Address - Street 1:610 EUCLID AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2951
Mailing Address - Country:US
Mailing Address - Phone:619-267-8181
Mailing Address - Fax:619-479-6750
Practice Address - Street 1:610 EUCLID AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2951
Practice Address - Country:US
Practice Address - Phone:619-267-8181
Practice Address - Fax:619-479-6750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37912173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA85069Medicare UPIN