Provider Demographics
NPI:1093534661
Name:BRAMBILA, LUIS ANDRADE (R1580940924)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ANDRADE
Last Name:BRAMBILA
Suffix:
Gender:M
Credentials:R1580940924
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 S WESTLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2906
Mailing Address - Country:US
Mailing Address - Phone:213-483-9205
Mailing Address - Fax:
Practice Address - Street 1:360 S WESTLAKE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2906
Practice Address - Country:US
Practice Address - Phone:213-483-9205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1508940924101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)