Provider Demographics
NPI:1902640360
Name:BRAGA, JUSTINE MARIE ALICAYA (FNP)
Entity type:Individual
Prefix:MS
First Name:JUSTINE MARIE
Middle Name:ALICAYA
Last Name:BRAGA
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:3605 LONG BEACH BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4024
Mailing Address - Country:US
Mailing Address - Phone:626-461-5638
Mailing Address - Fax:626-461-5697
Practice Address - Street 1:3605 LONG BEACH BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4024
Practice Address - Country:US
Practice Address - Phone:626-461-5638
Practice Address - Fax:626-461-5697
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA95086222163W00000X
CA95030640363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse