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NPI Code Detail

MEDICARE: BRANDON ADAM GAINES M.S.O.M, LAC

MEDICARE: BRANDON ADAM GAINES M.S.O.M, LAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171100000XAcupuncturistAC 10786CA
2101YA0400XAddiction (Substance Use Disorder) CounselorCA

General Provider Information

NPI Number : 1295759199
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDON ADAM GAINES M.S.O.M, LAC
Provider Business Mailing Address
First Line : 1454 S CREST DR
Second Line :
City : LOS ANGELES
State : CA
Zip : 90035-3312
Country : US
Telephone Number : 818-961-4046
Fax Number :
Provider Business Practice Location Address
First Line : 1454 S CREST DR
Second Line :
City : LOS ANGELES
State : CA
Zip : 90035-3312
Country : US
Telephone Number : 818-961-4046
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2006
Last Update Date : 02/15/2018

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