Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | D19330 | CA |
Y | 213EG0000X | General Practice | D19330 | CA |
NPI | 1003823501 |
---|---|
Provider Name | Dr. Dale Edwin Brandon |
First Address | Huntington Beach, CA 92648-1714 |
Second Address | Huntington Beach, CA 92648-1714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 08/07/2007 |