Provider Demographics
NPI:1710282629
Name:BRAND, BORIS YAKOV (NP)
Entity Type:Individual
Prefix:
First Name:BORIS
Middle Name:YAKOV
Last Name:BRAND
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6302 ATOLL AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY GLEN
Mailing Address - State:CA
Mailing Address - Zip Code:91401-2501
Mailing Address - Country:US
Mailing Address - Phone:323-428-4211
Mailing Address - Fax:
Practice Address - Street 1:600 ALFRED NOBEL DR STE A
Practice Address - Street 2:
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-1834
Practice Address - Country:US
Practice Address - Phone:510-984-1103
Practice Address - Fax:888-628-9895
Is Sole Proprietor?:No
Enumeration Date:2011-01-24
Last Update Date:2022-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 19248363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA638669OtherRN STATE LICENSE