Individual
BREANDA BANOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14624 SHERMAN WAY STE 404, VAN NUYS, CA 91405-2289
(818) 778-5406
Mailing address
14624 SHERMAN WAY STE 404, VAN NUYS, CA 91405-2289
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
08/31/2018
Last updated
08/31/2018
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