Provider Demographics
NPI:1497429484
Name:DE ANDA, BRIANNA GABRIEL
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:GABRIEL
Last Name:DE ANDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2271 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-2613
Mailing Address - Country:US
Mailing Address - Phone:510-909-3915
Mailing Address - Fax:
Practice Address - Street 1:4200 W CYPRESS ST STE 550
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-4285
Practice Address - Country:US
Practice Address - Phone:866-468-6471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2025-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician