Brandon Trac
Student in an Organized Health Care Education/Training Program in Los Angeles, CA. Individual provider (NPI-1).
NPI number1164059655
StatusActive
Last updated in NPPESDec 6, 2021
Details
- NPI
- 1164059655
- Entity type
- Individual (NPI-1)
- Name
- Brandon Trac
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 24, 2020
- Certification date
- Mar 25, 2020
- Last updated
- Dec 6, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | Yes |
Practice location
4733 W Sunset Blvd Fl 3Los Angeles, CA 90027-6021
Phone 323-783-4516
Mailing address
4733 W Sunset Blvd Fl 3Los Angeles, CA 90027-6021
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