Provider Demographics
NPI:1154356608
Name:BRAILOW, ANTHONY G (PHD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:G
Last Name:BRAILOW
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2181 S EL CAMINO REAL STE 101
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6267
Mailing Address - Country:US
Mailing Address - Phone:760-622-9662
Mailing Address - Fax:
Practice Address - Street 1:2181 S EL CAMINO REAL STE 101
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6267
Practice Address - Country:US
Practice Address - Phone:760-622-9662
Practice Address - Fax:760-650-7363
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12521103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical