Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 167465 | CA |
NPI | 1548670482 |
---|---|
Provider Name | Bryan Matthew Brandon |
First Address | San Clemente, CA 92673-2859 |
Second Address | San Clemente, CA 92673-2859 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2014 |
Last Update Date | 01/07/2021 |