MEDICARE: PATRICK BRANDAO

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1427753094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK BRANDAO

Provider Business Mailing Address
First Line	:	1229 N FLORES ST APT 6
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90069-2988
Country	:	US
Telephone Number	:	617-602-5489
Fax Number	:

Provider Business Practice Location Address
First Line	:	1249 S LA BREA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-1627
Country	:	US
Telephone Number	:	323-708-7500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2023
Last Update Date	:	09/05/2023

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