Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | A37912 | CA |
NPI | 1124039755 |
---|---|
Provider Name | Dr. Ira Richard Braverman |
First Address | National City, CA 91950 |
Second Address | National City, CA 91950 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A379120 | (05) | CA |
A85069 | (02) |