Provider Demographics
NPI:1184117830
Name:UBA, BRALYN
Entity type:Individual
Prefix:
First Name:BRALYN
Middle Name:
Last Name:UBA
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 1:1406 HOOKS DR
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-2214
Mailing Address - Country:US
Mailing Address - Phone:985-634-8881
Mailing Address - Fax:
Practice Address - Street 1:12561 WARDLINE RD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-6212
Practice Address - Country:US
Practice Address - Phone:985-551-5155
Practice Address - Fax:985-551-5222
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator