Individual provider Active NPI

Ryan Kelley Braun

  • Mental Health Counselor
  • San Diego, CA
National Provider Identifier
1720568736
Registry record updated Aug 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
4309 3Rd Ave
San Diego, CA 92103-1407
Phone
(619) 876-4502
NPI assigned
Aug 19, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

4309 3Rd Ave
San Diego, CA 92103-1407

Mailing address

3948 1/2 Mississippi St
San Diego, CA 92104-2733

Other identifiers 1

IdentifierTypeStateIssuer
775602719OtherTUFT HEALTH FREEDOM PLAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1534636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534636800000",
    "number": "1720568736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3948 1/2 MISSISSIPPI ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921042733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4309 3RD AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921031407",
            "telephone_number": "619-876-4502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAUN",
        "first_name": "RYAN",
        "middle_name": "KELLEY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-19",
        "last_updated": "2018-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFT HEALTH FREEDOM PLAN",
            "identifier": "775602719",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.