Provider Demographics
NPI:1700571668
Name:BRINES, VAUGHN KRZEMECKI
Entity Type:Individual
Prefix:
First Name:VAUGHN
Middle Name:KRZEMECKI
Last Name:BRINES
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 1:3031 BEVERLY BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-1013
Mailing Address - Country:US
Mailing Address - Phone:323-644-9380
Mailing Address - Fax:323-644-9380
Practice Address - Street 1:3031 BEVERLY BLVD STE B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-1013
Practice Address - Country:US
Practice Address - Phone:323-644-9380
Practice Address - Fax:323-644-9380
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician