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General NPI Number Information
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NPI Number | 1154689545
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Entity Type | Individual
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Provider Name | GEOFFREY VAN DEN BRANDE N.P.
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Gender | Male
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Dates
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Enumeration Date | 04/24/2012
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Last Update Date | 06/18/2019
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Provider Practice Location Address
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Address Line | 1501 TROUSDALE DR
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City | BURLINGAME
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State | CA
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Zip | 94010-4506
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Country | US
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Telephone | 415-715-4618
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 37TH AVE
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City | SAN FRANCISCO
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State | CA
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Zip | 94122-1332
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Country | US
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Telephone | 619-750-2811
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 20839
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License Number State | AZ
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