Provider Demographics
NPI:1356868269
Name:GRAMATA, BRITTANY NICOLE
Entity Type:Individual
Prefix:MS
First Name:BRITTANY
Middle Name:NICOLE
Last Name:GRAMATA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10344 CREST BROOK DR
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-2609
Mailing Address - Country:US
Mailing Address - Phone:951-675-5567
Mailing Address - Fax:
Practice Address - Street 1:10344 CREST BROOK DR
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-2609
Practice Address - Country:US
Practice Address - Phone:951-675-5567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA103K00000XOtherIBH