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NPI Code Detail

MEDICARE: BRANDON MICHAEL EDELBACH

MEDICARE: BRANDON MICHAEL EDELBACH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramCA

General Provider Information

NPI Number : 1336077106
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDON MICHAEL EDELBACH
Provider Business Mailing Address
First Line : 11234 ANDERSON ST
Second Line :
City : LOMA LINDA
State : CA
Zip : 92350-1716
Country : US
Telephone Number : 909-558-4952
Fax Number :
Provider Business Practice Location Address
First Line : 11234 ANDERSON ST
Second Line :
City : LOMA LINDA
State : CA
Zip : 92350-1716
Country : US
Telephone Number : 909-558-4952
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2026
Last Update Date : 05/12/2026

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Directions to “ BRANDON MICHAEL EDELBACH ” Practice Location

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