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General NPI Number Information
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NPI Number | 1427494707
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Entity Type | Individual
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Provider Name | DR. NATHAN BRANDON
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Gender | Male
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Dates
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Enumeration Date | 05/14/2013
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Last Update Date | 07/26/2024
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Provider Practice Location Address
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Address Line | 1606 MAYFAIR RD UNIT 301
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City | JACKSONVILLE
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State | FL
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Zip | 32207-2363
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Country | US
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Telephone | 415-993-2226
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Fax |
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Provider Business Mailing Address
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Address Line | 1606 MAYFAIR RD UNIT 301
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City | JACKSONVILLE
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State | FL
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Zip | 32207-2363
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Country | US
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Telephone | 415-993-2226
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY29515
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License Number State | CA
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