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NPI Code Detail

MEDICARE: ANGELO CHRISTIAN BRAYE

MEDICARE: ANGELO CHRISTIAN BRAYE
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1780253203
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELO CHRISTIAN BRAYE
Provider Business Mailing Address
First Line : 1605 W OLYMPIC BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90015-3808
Country : US
Telephone Number : 612-598-6861
Fax Number :
Provider Business Practice Location Address
First Line : 1605 W OLYMPIC BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90015-3808
Country : US
Telephone Number : 612-598-6861
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2021
Last Update Date : 06/19/2021

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Directions to “ ANGELO CHRISTIAN BRAYE ” Practice Location

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