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NPI Code Detail

MEDICARE: MR. JONATHAN L BRAND MD

MEDICARE: MR. JONATHAN L BRAND MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianG50045CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1120523OTHERCALA CO MENTAL HEALTH
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1548259401
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JONATHAN L BRAND MD
Provider Business Mailing Address
First Line : PO BOX 4570
Second Line :
City : PALOS VERDES PENINSULA
State : CA
Zip : 90274-9607
Country : US
Telephone Number : 424-400-7748
Fax Number : 424-400-7749
Provider Business Practice Location Address
First Line : 3630 E IMPERIAL HWY
Second Line :
City : LYNWOOD
State : CA
Zip : 90262-2609
Country : US
Telephone Number : 310-900-8662
Fax Number : 424-400-7749
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2005
Last Update Date : 12/13/2019

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