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General NPI Number Information
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NPI Number | 1902665763
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Entity Type | Individual
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Provider Name | MR. BRANDON LE TRAM
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Gender | Male
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Dates
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Enumeration Date | 03/15/2024
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Last Update Date | 03/15/2024
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Provider Practice Location Address
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Address Line | 15504 S NORMANDIE AVE
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City | GARDENA
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State | CA
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Zip | 90247-4014
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Country | US
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Telephone | 310-650-9947
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Fax |
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Provider Business Mailing Address
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Address Line | 2035 W 144TH ST
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City | GARDENA
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State | CA
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Zip | 90249-2921
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Country | US
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Telephone | 310-650-9947
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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