Provider Demographics
NPI:1780253203
Name:BRAYE, ANGELO CHRISTIAN
Entity type:Individual
Prefix:
First Name:ANGELO
Middle Name:CHRISTIAN
Last Name:BRAYE
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 1:1605 W OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3808
Mailing Address - Country:US
Mailing Address - Phone:612-598-6861
Mailing Address - Fax:
Practice Address - Street 1:1605 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3808
Practice Address - Country:US
Practice Address - Phone:612-598-6861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-19
Last Update Date:2021-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst