Provider Demographics
NPI:1699073569
Name:LA BRAMASOLE
Entity type:Organization
Organization Name:LA BRAMASOLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCGUCKIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHDC
Authorized Official - Phone:208-755-0316
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PO BOX 191
Mailing Address - City:OAKESDALE
Mailing Address - State:WA
Mailing Address - Zip Code:99158-0191
Mailing Address - Country:US
Mailing Address - Phone:208-755-0316
Mailing Address - Fax:509-444-6606
Practice Address - Street 1:715 S WHITMAN ST
Practice Address - Street 2:
Practice Address - City:ROSALIA
Practice Address - State:WA
Practice Address - Zip Code:99170
Practice Address - Country:US
Practice Address - Phone:208-755-0316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603037066251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management