Provider Demographics
NPI:1992415186
Name:BRACAMONTE, BREANNA RAE
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:RAE
Last Name:BRACAMONTE
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 1:11502 CLARION RIVER DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-9440
Mailing Address - Country:US
Mailing Address - Phone:661-868-4316
Mailing Address - Fax:
Practice Address - Street 1:11502 CLARION RIVER DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-9440
Practice Address - Country:US
Practice Address - Phone:661-868-4316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator