Individual
LANE BRAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1115 S SUNSET AVE, WEST COVINA, CA 91790-3940
(626) 814-2434
Mailing address
678 SILVER VALLEY TRL, WALNUT, CA 91789-2085
(909) 594-4533
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
PA11948
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PA11948
—
CA
Enumeration date
06/02/2006
Last updated
07/08/2007
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