Provider Demographics
NPI:1639105463
Name:METZ, BRANDIE JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRANDIE
Middle Name:JEAN
Last Name:METZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRANDIE
Other - Middle Name:JEAN
Other - Last Name:RUIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3500 BARRANCA PKWY
Mailing Address - Street 2:SUITE 160
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-8226
Mailing Address - Country:US
Mailing Address - Phone:949-336-6569
Mailing Address - Fax:949-336-6570
Practice Address - Street 1:3500 BARRANCA PKWY
Practice Address - Street 2:SUITE 160
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-8226
Practice Address - Country:US
Practice Address - Phone:949-336-6569
Practice Address - Fax:949-336-6570
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86073207N00000X, 207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA86073AMedicare ID - Type Unspecified
CAPENDINGMedicaid
CAI11791Medicare UPIN