Provider Demographics
NPI:1811393044
Name:BRISAS IOP, LLC
Entity Type:Organization
Organization Name:BRISAS IOP, LLC
Other - Org Name:BRISAS IOP
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJAGOPAL
Authorized Official - Middle Name:KEERTHY
Authorized Official - Last Name:SUNDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:510-685-2022
Mailing Address - Street 1:3060 EL CERRITO PLZ
Mailing Address - Street 2:STE 266
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-4011
Mailing Address - Country:US
Mailing Address - Phone:510-685-2022
Mailing Address - Fax:
Practice Address - Street 1:5700 DIVISION ST
Practice Address - Street 2:STE 200
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3257
Practice Address - Country:US
Practice Address - Phone:510-685-2022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA942233261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder