Provider Demographics
NPI:1316553548
Name:LASCANO, BRIANA RENE (AA)
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:RENE
Last Name:LASCANO
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7852 1ST ST APT 7
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680-1647
Mailing Address - Country:US
Mailing Address - Phone:714-616-4072
Mailing Address - Fax:
Practice Address - Street 1:12235 BEACH BLVD STE 110
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-3943
Practice Address - Country:US
Practice Address - Phone:714-898-7828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician