Provider Demographics
NPI:1730385394
Name:BRAHMOPALA, DUANGDEUN JEAN (PSYD, NP, CNS)
Entity type:Individual
Prefix:
First Name:DUANGDEUN
Middle Name:JEAN
Last Name:BRAHMOPALA
Suffix:
Gender:F
Credentials:PSYD, NP, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:855 OAK KNOLL ST
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-2039
Mailing Address - Country:US
Mailing Address - Phone:626-480-5212
Mailing Address - Fax:626-480-5231
Practice Address - Street 1:1502 W WEST COVINA PKWY
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2703
Practice Address - Country:US
Practice Address - Phone:626-480-5212
Practice Address - Fax:626-480-5231
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPHN25309163W00000X
CARN275643163W00000X
CAPMH535163WP0808X
CANP16310363L00000X
CACNS1139364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Not Answered364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health