Provider Demographics
NPI:1407296932
Name:BRIGHT, BRANDON DAVID (LAC)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:DAVID
Last Name:BRIGHT
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:434 LENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3215
Mailing Address - Country:US
Mailing Address - Phone:714-206-7883
Mailing Address - Fax:
Practice Address - Street 1:6324 E PACIFIC COAST HWY STE C
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4841
Practice Address - Country:US
Practice Address - Phone:562-493-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-28
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15483171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist