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Individual

DENISE D. BRATHWAITE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
1300 W 7TH ST, SAN PEDRO, CA 90732-3505
(310) 832-3311
Mailing address
PO BOX 3129, TORRANCE, CA 90510-3129
(310) 792-3914
(855) 898-4055

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
G58680
CA
208VP0000X
Pain Medicine Physician
G58680
CA
208VP0014X
Interventional Pain Medicine Physician
G58680
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00G586800
BLUE SHIELD
CA
Enumeration date
06/10/2006
Last updated
06/02/2015
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