Provider Demographics
NPI:1790663276
Name:BRACERO, MAXINE YASMINE (CMA)
Entity type:Individual
Prefix:MS
First Name:MAXINE
Middle Name:YASMINE
Last Name:BRACERO
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3445
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-9373
Mailing Address - Country:US
Mailing Address - Phone:209-649-6010
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 3445
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95156-3445
Practice Address - Country:US
Practice Address - Phone:209-640-6010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-23
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA376J00000X, 253Z00000X, 374U00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care