Provider Demographics
NPI:1700509718
Name:LONG, BRAHM L
Entity Type:Individual
Prefix:
First Name:BRAHM
Middle Name:L
Last Name:LONG
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 1:230 W ALAMAR AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3747
Mailing Address - Country:US
Mailing Address - Phone:805-708-8355
Mailing Address - Fax:
Practice Address - Street 1:230 W ALAMAR AVE APT 5
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3747
Practice Address - Country:US
Practice Address - Phone:805-708-8355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker