Healthcare Provider Details

I. General information

NPI: 1700463189
Provider Name (Legal Business Name): BRANDEISMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PARK PL STE 140
SAN RAMON CA
94583-4460
US

IV. Provider business mailing address

100 PARK PL STE 140
SAN RAMON CA
94583-4460
US

V. Phone/Fax

Practice location:
  • Phone: 925-255-7867
  • Fax:
Mailing address:
  • Phone: 925-255-7867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JUDSON BRANDEIS
Title or Position: OWNER
Credential: MD
Phone: 925-255-7867