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General NPI Number Information
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NPI Number | 1922176403
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Entity Type | Individual
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Provider Name | BRANDON JEREMY VANCE MD
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Gender | Male
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 05/09/2020
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Provider Practice Location Address
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Address Line | 5625 COLLEGE AVE STE 215
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City | OAKLAND
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State | CA
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Zip | 94618-1585
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Country | US
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Telephone | 415-640-6498
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Fax | 239-320-9286
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Provider Business Mailing Address
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Address Line | 5625 COLLEGE AVE STE 215
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City | OAKLAND
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State | CA
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Zip | 94618-1585
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Country | US
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Telephone | 415-640-6498
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Fax | 239-320-9286
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A83474
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License Number State | CA
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