Healthcare Provider Details

I. General information

NPI: 1710282629
Provider Name (Legal Business Name): BORIS YAKOV BRAND NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 ALFRED NOBEL DR STE A
HERCULES CA
94547-1834
US

IV. Provider business mailing address

6302 ATOLL AVE
VALLEY GLEN CA
91401-2501
US

V. Phone/Fax

Practice location:
  • Phone: 510-984-1103
  • Fax: 888-628-9895
Mailing address:
  • Phone: 323-428-4211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberSP033250
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberSP033250
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberNP 19248
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: