Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | G25958 | CA |
NPI | 1184700114 |
---|---|
Provider Name | Dr. Samuel John Braitman |
First Address | Los Angeles, CA 90034-1702 |
Second Address | Los Angeles, CA 90034-1702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A 42855 | (02) | CA |