Healthcare Provider Details

I. General information

NPI: 1477374486
Provider Name (Legal Business Name): BRANDON JAMES SMALLWOOD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16823 ARROW BLVD
FONTANA CA
92335-3803
US

IV. Provider business mailing address

25910 ACERO STE 160
MISSION VIEJO CA
92691-2777
US

V. Phone/Fax

Practice location:
  • Phone: 909-355-3888
  • Fax:
Mailing address:
  • Phone: 877-527-7227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number122766
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: