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General NPI Number Information
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NPI Number | 1659641702
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Entity Type | Organization
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Legal Business Name | JONATHAN LEONARD BRAND, M.D., A MEDICAL CORPORATION
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Dates
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Enumeration Date | 01/06/2012
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Last Update Date | 02/22/2013
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Provider Practice Location Address
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Address Line | 3630 E IMPERIAL HWY
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City | LYNWOOD
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State | CA
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Zip | 90262-2636
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Country | US
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Telephone | 310-701-7830
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Fax | 310-645-5532
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Provider Business Mailing Address
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Address Line | 4314 MARINA CITY DR SUITE 1118CTS
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City | MARINA DEL REY
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State | CA
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Zip | 90292-5816
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Country | US
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Telephone | 310-306-6150
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Fax | 310-645-5532
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Authorized Official
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Title or Position | OWNER
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Name | DR. JONATHAN LEONARD BRAND
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Credential | M. D.
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Telephone | 310-306-6150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number | G50045
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License Number State | CA
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