Provider Demographics
NPI:1457770737
Name:BRANNAN, RAINA MARY
Entity Type:Individual
Prefix:MRS
First Name:RAINA
Middle Name:MARY
Last Name:BRANNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RAINA
Other - Middle Name:FARID
Other - Last Name:AZIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5005 TEXAS ST STE 203
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3723
Mailing Address - Country:US
Mailing Address - Phone:619-692-0727
Mailing Address - Fax:619-692-0785
Practice Address - Street 1:5005 TEXAS ST STE 203
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3723
Practice Address - Country:US
Practice Address - Phone:619-692-0727
Practice Address - Fax:619-692-0785
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator