Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003380114 |
---|---|
Provider Name | Brandon Walter Oare |
First Address | Riverside, CA 92508-9523 |
Second Address | Riverside, CA 92508-9523 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2019 |
Last Update Date | 11/01/2019 |