Provider Demographics
NPI:1164915856
Name:BRACAMONTES, JESUS (RADT 1)
Entity Type:Individual
Prefix:MR
First Name:JESUS
Middle Name:
Last Name:BRACAMONTES
Suffix:
Gender:M
Credentials:RADT 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 N BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-1457
Mailing Address - Country:US
Mailing Address - Phone:657-231-6099
Mailing Address - Fax:
Practice Address - Street 1:2727 N BRISTOL ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-1457
Practice Address - Country:US
Practice Address - Phone:657-231-6099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)