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General NPI Number Information
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NPI Number | 1518866755
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Entity Type | Individual
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Provider Name | BRANDON KENNETH MITCHELL RAD-T
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Gender | Male
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Dates
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Enumeration Date | 11/03/2026
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Last Update Date | 11/03/2026
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Provider Practice Location Address
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Address Line | 239 W 9TH ST
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City | UPLAND
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State | CA
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Zip | 91786-5979
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Country | US
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Telephone | 909-490-6284
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Fax |
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Provider Business Mailing Address
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Address Line | 11747 BRANDYWINE PL
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3915
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Country | US
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Telephone | 840-256-7102
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | CA
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