Healthcare Provider Details

I. General information

NPI: 1396609053
Provider Name (Legal Business Name): BRANDON DRAYTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MARIN ST STE 225
THOUSAND OAKS CA
91360-4301
US

IV. Provider business mailing address

501 MARIN ST STE 225
THOUSAND OAKS CA
91360-4301
US

V. Phone/Fax

Practice location:
  • Phone: 805-379-1401
  • Fax:
Mailing address:
  • Phone: 805-379-1401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: