Provider Demographics
NPI:1093410250
Name:BLUMENFELD, BRANDON HUNTER (LAC)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:HUNTER
Last Name:BLUMENFELD
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 QUEENSBURY DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-4522
Mailing Address - Country:US
Mailing Address - Phone:310-948-6443
Mailing Address - Fax:
Practice Address - Street 1:2920 QUEENSBURY DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-4522
Practice Address - Country:US
Practice Address - Phone:310-948-6443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC19238171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist