Provider Demographics
NPI:1902665763
Name:TRAM, BRANDON LE
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:LE
Last Name:TRAM
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 1:2035 W 144TH ST
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-2921
Mailing Address - Country:US
Mailing Address - Phone:310-650-9947
Mailing Address - Fax:
Practice Address - Street 1:15504 S NORMANDIE AVE
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4014
Practice Address - Country:US
Practice Address - Phone:310-650-9947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist