Provider Demographics
NPI:1982809877
Name:BRAGG, ELIZABETH ALEXIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ALEXIS
Last Name:BRAGG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:ALEXIS
Other - Last Name:CHARNOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1750 CAMINO PALMERO ST APT 440
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-2984
Mailing Address - Country:US
Mailing Address - Phone:412-527-6610
Mailing Address - Fax:
Practice Address - Street 1:4650 SUNSET BLVD MS#3
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027
Practice Address - Country:US
Practice Address - Phone:323-361-5591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD70758208000000X
CA134893207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics