Healthcare Provider Details

I. General information

NPI: 1356011936
Provider Name (Legal Business Name): BRANDON SCOTT MORRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23181 VERDUGO DR STE 103A
LAGUNA HILLS CA
92653-1313
US

IV. Provider business mailing address

27121 PUEBLONUEVO DR
MISSION VIEJO CA
92691-4415
US

V. Phone/Fax

Practice location:
  • Phone: 949-366-1053
  • Fax:
Mailing address:
  • Phone: 949-463-4775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95017798
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: