Healthcare Provider Details

I. General information

NPI: 1316671282
Provider Name (Legal Business Name): BRANDON G HUANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35400 BOB HOPE DR STE 207
RANCHO MIRAGE CA
92270-1774
US

IV. Provider business mailing address

12383 HELENA WAY
RANCHO CUCAMONGA CA
91739-2650
US

V. Phone/Fax

Practice location:
  • Phone: 760-832-6287
  • Fax:
Mailing address:
  • Phone: 909-532-1702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number79038
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: