Provider Demographics
NPI:1821250739
Name:BRAUD, VANESSA ANNE (LVN)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:ANNE
Last Name:BRAUD
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 FLAGSTAFF CT
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-5782
Mailing Address - Country:US
Mailing Address - Phone:562-252-0617
Mailing Address - Fax:
Practice Address - Street 1:14530 HAMLIN ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1607
Practice Address - Country:US
Practice Address - Phone:818-373-8422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA221793101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health