Provider Demographics
NPI:1497915631
Name:BRANDON, MARILYN JOYCE
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:JOYCE
Last Name:BRANDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 STONE CANYON DR
Mailing Address - Street 2:P. O. BOX 26
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4041
Mailing Address - Country:US
Mailing Address - Phone:916-397-0584
Mailing Address - Fax:916-783-0415
Practice Address - Street 1:1617 STONE CANYON DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4041
Practice Address - Country:US
Practice Address - Phone:916-397-0584
Practice Address - Fax:916-783-0415
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver