Individual
PETER MATTHEW BRACKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
1828 S WESTERN AVE, SUITE 10, LOS ANGELES, CA 90006-5808
(323) 730-0310
(323) 730-1335
Mailing address
5415 NEWCASTLE AVE, #6, ENCINO, CA 91316-2012
(818) 335-3345
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA14573
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA14573
MEDICAL LICENSE NUMBER
CA
Enumeration date
06/26/2006
Last updated
02/02/2015
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