Provider Demographics
NPI:1992343412
Name:BRACAMONTES, ALLISON DIANE
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:DIANE
Last Name:BRACAMONTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 KIRBY LEE ST
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-8615
Mailing Address - Country:US
Mailing Address - Phone:512-983-7188
Mailing Address - Fax:
Practice Address - Street 1:2005 KIRBY LEE ST
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-8615
Practice Address - Country:US
Practice Address - Phone:512-983-7188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer