Provider Demographics
NPI:1639785868
Name:BRAMBILA, RICARDO (LMT)
Entity Type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:
Last Name:BRAMBILA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 N KENT ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-1103
Mailing Address - Country:US
Mailing Address - Phone:714-336-1499
Mailing Address - Fax:
Practice Address - Street 1:1728 N KENT ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-1103
Practice Address - Country:US
Practice Address - Phone:714-336-1499
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
CA1678225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist