Healthcare Provider Details

I. General information

NPI: 1750702866
Provider Name (Legal Business Name): ANGELA BRANDON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2013
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 WILLOW PASS RD # 200
CONCORD CA
94520-5823
US

IV. Provider business mailing address

1420 WILLOW PASS RD # 200
CONCORD CA
94520-5823
US

V. Phone/Fax

Practice location:
  • Phone: 925-646-5480
  • Fax: 925-646-5622
Mailing address:
  • Phone: 925-646-5480
  • Fax: 925-646-5622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-LFSJUM
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: