Provider Demographics
NPI:1356952279
Name:ABRAM, BREANNA RENEE
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:RENEE
Last Name:ABRAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 N MADISON AVE APT 311
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-4476
Mailing Address - Country:US
Mailing Address - Phone:310-892-0895
Mailing Address - Fax:
Practice Address - Street 1:447 N EL MOLINO AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1403
Practice Address - Country:US
Practice Address - Phone:626-577-8480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program