=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316322902
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA JULIANA BRAMEL MFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2015
-----------------------------------------------------
Last Update Date | 08/12/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5055 CANYON CREST DR STE 214
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92507-6015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-232-3476
-----------------------------------------------------
Fax | 951-783-9199
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5055 CANYON CREST DR. SUIE 214
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-232-3476
-----------------------------------------------------
Fax | 951-783-9199
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 89394
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------