Individual
BRANDON CHARLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2714 CANAL ST, NEW ORLEANS, LA 70119-5548
(504) 301-2888
Mailing address
4840 LAFON DR, NEW ORLEANS, LA 70126-4122
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1356720866
FUTURE WINNERS
LA
05
—
1356720866
—
LA
Enumeration date
12/29/2017
Last updated
10/30/2018
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