Basic Information
| Provider Information | |||||||||
| NPI: | 1679701668 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRANSON | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | PUALANI | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L.P.T. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ARANITA | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | PUALANI | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | L.P.T. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1911 WILLIAMS DR | ||||||||
| Address2: | STE #165 | ||||||||
| City: | OXNARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930362612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8773274747 | ||||||||
| FaxNumber: | 8059819268 | ||||||||
| Practice Location | |||||||||
| Address1: | 1911 WILLIAMS DR | ||||||||
| Address2: | STE #165 | ||||||||
| City: | OXNARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930362612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8773274747 | ||||||||
| FaxNumber: | 8059819268 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2009 | ||||||||
| LastUpdateDate: | 06/29/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | PT 24230 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.