Doctor Name: | ROBERT BRIAN BRAITHWAITE |
NPI Number: | 1023317773 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 12755 Brookhurst St Ste114 Garden Grove, CA - 928404857 |
Business Phone Number: | 7146388277 |
Business Fax Number: | |
Mailing Address: | 229 E Commonwealth Ave, 230 FULLERTON |
State: | CA |
Postal Code: | 928324903 |
Phone Number: | 7149750104 |
Fax Number: | |
NPI Enumeration Date: | 03/21/2011 |
NPI Last Update Date: | 03/21/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |