Healthcare Provider Details

I. General information

NPI: 1720225642
Provider Name (Legal Business Name): BRANDON ANDREW YAKUSH PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 09/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10333 EL CAMINO REAL
ATASCADERO CA
93422-5808
US

IV. Provider business mailing address

1600 9TH STREET, ROOM 150 FISCAL ALLOCATIONS AND ESTIMATES UNIT
SACRAMENTO CA
95814-6414
US

V. Phone/Fax

Practice location:
  • Phone: 805-468-2000
  • Fax: 805-468-6011
Mailing address:
  • Phone: 916-651-9475
  • Fax: 916-651-8908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY21803
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY21803
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: