Provider Demographics
NPI:1558407510
Name:VANNOORD, BRANDON A (MD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:A
Last Name:VANNOORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BRANDON
Other - Middle Name:ALAN
Other - Last Name:VANNOORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9850 GENESEE AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1208
Mailing Address - Country:US
Mailing Address - Phone:858-554-1212
Mailing Address - Fax:858-554-1222
Practice Address - Street 1:3969 4TH AVE STE 208
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3165
Practice Address - Country:US
Practice Address - Phone:619-849-5777
Practice Address - Fax:619-849-5776
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2021-08-23
Deactivation Date:2019-02-11
Deactivation Code:
Reactivation Date:2019-02-15
Provider Licenses
StateLicense IDTaxonomies
CAA113568207LP2900X, 208VP0014X
NE23831208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice