Provider Demographics
NPI:1508343377
Name:PIMENTEL, BRAULIO
Entity Type:Individual
Prefix:
First Name:BRAULIO
Middle Name:
Last Name:PIMENTEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 RIVERSIDE DR APT 51
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-1013
Mailing Address - Country:US
Mailing Address - Phone:714-653-8910
Mailing Address - Fax:
Practice Address - Street 1:1326 RIVERSIDE DR APT 51
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-1013
Practice Address - Country:US
Practice Address - Phone:714-653-8910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health