Healthcare Provider Details

I. General information

NPI: 1366364424
Provider Name (Legal Business Name): BRANDON FUKUDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

398 TRALEE LN
ALAMEDA CA
94502-7730
US

IV. Provider business mailing address

398 TRALEE LN
ALAMEDA CA
94502-7730
US

V. Phone/Fax

Practice location:
  • Phone: 626-673-7526
  • Fax:
Mailing address:
  • Phone: 626-673-7526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number23732
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: