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General NPI Number Information
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NPI Number | 1932998606
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Entity Type | Individual
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Provider Name | CORNELIA BRANDON
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Gender |
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Dates
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Enumeration Date | 05/01/2025
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 15809 MCINTOSH AVE
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City | CHINO
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State | CA
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Zip | 91708-9352
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Country | US
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Telephone | 951-660-4004
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1898
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City | CHINO HILLS
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State | CA
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Zip | 91709-0064
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW87563
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License Number State | CA
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