Healthcare Provider Details

I. General information

NPI: 1699925941
Provider Name (Legal Business Name): RICHARD D. BRAND, M.D., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 10/12/2018
Certification Date:
Deactivation Date: 05/07/2009
Reactivation Date: 10/12/2018

III. Provider practice location address

2241 WANKEL WAY STE B
OXNARD CA
93030-0191
US

IV. Provider business mailing address

2241 WANKEL WAY STE B
OXNARD CA
93030-0191
US

V. Phone/Fax

Practice location:
  • Phone: 805-983-0425
  • Fax: 805-983-0414
Mailing address:
  • Phone: 805-983-0425
  • Fax: 805-983-0414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberG30006
License Number StateCA

VIII. Authorized Official

Name: DR. RICAHRD DANIEL BRAND
Title or Position: DOCTOR
Credential: M.D.
Phone: 805-983-0425