Healthcare Provider Details

I. General information

NPI: 1548259401
Provider Name (Legal Business Name): JONATHAN L BRAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3630 E IMPERIAL HWY
LYNWOOD CA
90262-2609
US

IV. Provider business mailing address

PO BOX 4570
PALOS VERDES PENINSULA CA
90274-9607
US

V. Phone/Fax

Practice location:
  • Phone: 310-900-8662
  • Fax: 424-400-7749
Mailing address:
  • Phone: 424-400-7748
  • Fax: 424-400-7749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG50045
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: