Individual
AUDREANA JUSTINE BRANCACCIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4060 FAIRMOUNT AVE, SAN DIEGO, CA 92105-1608
(619) 255-9155
Mailing address
4060 FAIRMOUNT AVE, SAN DIEGO, CA 92105-1608
(619) 255-9155
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA66000
CA
Other
Enumeration date
09/19/2023
Last updated
03/31/2025
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