DR. DERALD E BRACKMANN


Address: 2100 W 3rd St Ste 111, Los Angeles, CA 90057-1999
Phone: 2134839930

DR. DERALD E BRACKMANN (NPI# 1508876699) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1508876699
Entity Type Individual
Full Name DR. DERALD E BRACKMANN
Credential MD
Practice Address 2100 W 3rd St Ste 111
Los Angeles
CA 90057-1999
Practice Telephone 2134839930
Practice Fax Number 2134830905
Mailing Telephone 2134839930
Mailing Fax Number 2134830905
Enumeration Date 2006-08-09
Last Update Date 2013-09-03
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207YX0901X Otolaryngology
Specialization: Otology & Neurotology
G11124 CA Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
CA 00G111240 05

Office Location

Street Address 2100 W 3RD ST STE 111
City LOS ANGELES
State CA
Zip Code 90057-1999

Providers in the same location

NPI Name Taxonomy Address Enumeration
1396239745 Soo Ji Jang Audiologist 2100 W 3rd St Ste 111, Los Angeles, CA 90057-1999 2018-06-19
1659892149 Diana Ahn Audiologist 2100 W 3rd St Ste 111, Los Angeles, CA 90057-1999 2017-07-05
1427397843 Caithlin E. Macneil Audiologist 2100 W 3rd St Ste 111, Los Angeles, CA 90057-1999 2013-02-05
1245556653 Kevin Albert Peng Otolaryngology 2100 W 3rd St Ste 111, Los Angeles, CA 90057-1999 2010-04-09
1124292719 Jane M. Gay Audiologist 2100 W 3rd St Ste 111, Los Angeles, CA 90057-1922 2008-04-15
1942414479 Dawna Maria Mills Audiologist 2100 W 3rd St Ste 111, Los Angeles, CA 90057-1922 2007-05-10
1013122555 Cheryl Jeanne Ruhlen Audiologist 2100 W 3rd St Ste 111, Los Angeles, CA 90057-1922 2007-05-10
1649485178 Allen John Senne Audiologist 2100 W 3rd St Ste 111, Los Angeles, CA 90057-1922 2007-05-10
1306962550 Wadad J Shalhub Audiologist-Hearing Aid Fitter 2100 W 3rd St Ste 111, Los Angeles, CA 90057-1999 2007-03-21
1821121427 House Clinic Audiologist 2100 W 3rd St Ste 111, Los Angeles, CA 90057-1922 2007-03-13
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1013518315 Mayulee Wilawanwelsh Massage Therapist 349 S Lafayette Pk Pl, Los Angeles, CA 90057 2020-11-03
1437714615 Jackeline L Ramon Social Worker 572 S. La Fayette Park Place #6, Los Angeles, CA 90057 2019-05-03
1467015743 Chanhwi Jung Acupuncturist 349 South Lafayette Park Place, #208, Los Angeles, CA 90057 2019-04-22
1356818850 Anshim Acupuncture Inc Acupuncturist 4501 Alameda St., #107b #115, Los Angeles, CA 90057 2018-11-01
1538634670 Karina Herrera Case Manager/Care Coordinator 679 S. Hampshire Ave, Los Angeles, CA 90057 2018-10-04
1306323506 Jessica Myung Jin Yun Counselor 520 S Lafayette Park Pl, Unit 300, Los Angeles, CA 90057 2018-07-20
1851887012 Scott Moon Dentist 2426 W. 8th St. #209, Los Angeles, CA 90057 2018-07-10
1780176107 Bianca Zafiro Case Manager/Care Coordinator 672 S Lafayette Park Place, Suite 6, Los Angeles, CA 90057 2018-06-01
1639677438 Claudia E Vides Inc A Dental Corporation Clinic/Center 2033 W. 7th Street, Los Angeles, CA 90057 2018-01-26
1720596414 Hee Sun No Pharmacist 269 S Lafayette Park Pl, 210, Los Angeles, CA 90057 2018-01-16
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Taxonomy Information

Taxonomy Code 207YX0901X
Grouping Allopathic & Osteopathic Physicians
Classification Otolaryngology
Specialization Otology & Neurotology

Taxonomy Definition

An otolaryngologist who treats diseases of the ear and temporal bone, including disorders of hearing and balance. The additional training in otology and neurotology emphasizes the study of embryology, anatomy, physiology, epidemiology, pathophysiology, pathology, genetics, immunology, microbiology and the etiology of diseases of the ear and temporal bone.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1629075635 John Steven Oghalai Otolaryngology 1450 San Pablo St Ste 5100, Los Angeles, CA 90033-4500 2005-07-05
1245556653 Kevin Albert Peng Otolaryngology 2100 W 3rd St Ste 111, Los Angeles, CA 90057-1999 2010-04-09
1790017960 Nopawan Vorasubin Otolaryngology 4867 W Sunset Blvd, Los Angeles, CA 90027-5969 2010-02-12
1598998502 South Coast Diagnostic Medical Group Otolaryngology 7095 Hollywood Blvd, 742, Los Angeles, CA 90028-8903 2009-08-25
1730315425 Brian Shinrong Chen Otolaryngology 2100 W 3rd St, Suite 111, Los Angeles, CA 90057-1944 2009-06-08
1033399498 Universal Diagnostic Medical Group, Inc. Otolaryngology 4322 Wilshire Blvd, Ste 303, Los Angeles, CA 90010-3793 2007-11-13
1417051095 John W House Otolaryngology 2100 W 3rd St, Suite 111, Los Angeles, CA 90057-1944 2006-09-12
1982708558 Rick A Friedman Otolaryngology 1520 San Pablo St, 4th Floor, Los Angeles, CA 90033-5310 2006-09-12

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1962845834 Yuan Liu Otolaryngology 11234 Anderson St Rm 2586a, Loma Linda, CA 92354-2804 2013-04-10
1699017301 Shohet Ear Associates Medical Group Inc Otolaryngology 770 Pacific Coast Hwy, Seal Beach, CA 90740-6379 2013-03-20
1801152665 Center for Fall Prevention, A Medical Corporation Otolaryngology 3831 Hughes Ave Ste 608, Culver City, CA 90232-6851 2012-04-05
1700151909 Stuart Gerard Gherini Otolaryngology 1056 38th St, Sacramento, CA 95816-5513 2012-03-20
1144420738 Shohet Ear Associates Medical Group Inc Otolaryngology 446 Old Newport Beach Blvd, Shohet Ear Associates Medical Group Inc, Newport Beach, CA 92663-4246 2007-07-20
1952426017 Hernan Goldsztein Otolaryngology 530 Lomas Santa Fe Dr Ste 1, Solana Beach, CA 92075-1350 2007-03-20
1932253960 Hana T. Bui, Md, A Professional Corporation Otolaryngology 1321 N Harbor Blvd Ste 101, Fullerton, CA 92835-4129 2007-01-23
1356344022 Kevin X Mckennan Otolaryngology 1111 Exposition Blvd Bldg 700, Sacramento, CA 95815-4314 2005-05-24
1144873613 Doron Sagiv Otolaryngology 2521 Stockton Blvd Ste 7200, Sacramento, CA 95817-2207 2019-07-23
1699288027 Haley Morgan Roberson Otolaryngology 1900 University Ave Ste 101, East Palo Alto, CA 94303-2213 2017-11-07
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Competitor

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City LOS ANGELES
Zip Code 90057

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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