Provider Demographics
NPI:1902633761
Name:BRAZZI, QUENTEN (SUDRC16955)
Entity type:Individual
Prefix:
First Name:QUENTEN
Middle Name:
Last Name:BRAZZI
Suffix:
Gender:M
Credentials:SUDRC16955
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 PRADO RD
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7313
Mailing Address - Country:US
Mailing Address - Phone:805-457-3331
Mailing Address - Fax:805-457-3332
Practice Address - Street 1:34 PRADO RD
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7313
Practice Address - Country:US
Practice Address - Phone:805-457-3331
Practice Address - Fax:805-457-3332
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASUDRC16955101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)