Jesus Sandro Bracamontes Barragan, LVN

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

710315 Issued in CA

Practice address

3853 Rosecrans St
San Diego, CA 92110-3115

Phone

(619) 692-8200

NPI assigned

Jun 1, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1590969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699920000000",
    "number": "1609490002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3853 ROSECRANS ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921103115",
            "telephone_number": "619-692-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3853 ROSECRANS ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921103115",
            "telephone_number": "619-692-8200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6991 Balboa Ave Rm 70",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921113447",
            "country_code": "US",
            "telephone_number": "858-496-8232",
            "fax_number": "858-496-8234",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRACAMONTES BARRAGAN",
        "first_name": "JESUS",
        "middle_name": "SANDRO",
        "credential": "LVN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-06-01",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "710315",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacklyn Madison Bozarth
• Miriah Bozeman
• Mary Bozigian
• Samuel A Bozzette, MD, PHD
• Rick Braatz
• Judy Evelyn Bracamontes
• Jennifer Elizabeth Brackett, PT, DPT
• Rachel Elizabeth Brackett, MS, OTR/L
• Samantha Lynne Brackett, MD
• Mary Joan Brackin, HEALTH COACH

• Licensed Vocational Nurse in San Diego, CA
• Providers in San Diego, CA by specialty
• Licensed Vocational Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.