Provider Demographics
NPI:1538245931
Name:BRAUNINGER, ANDREA LEIGH (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:LEIGH
Last Name:BRAUNINGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93410-9001
Mailing Address - Country:US
Mailing Address - Phone:805-756-1211
Mailing Address - Fax:805-756-5298
Practice Address - Street 1:CALIFORNIA POLYTECHNIC STATE UNIVERSITY STUDENT HEALTH
Practice Address - Street 2:1 GRAND AVE
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93410-0001
Practice Address - Country:US
Practice Address - Phone:805-756-1211
Practice Address - Fax:805-756-5298
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25034208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice