Provider Demographics
NPI:1801398318
Name:LEW, BRANDON ALEXANDER
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:ALEXANDER
Last Name:LEW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5086 S FORESTDALE CIR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-8747
Mailing Address - Country:US
Mailing Address - Phone:925-577-7142
Mailing Address - Fax:
Practice Address - Street 1:311 RAY ST
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-6621
Practice Address - Country:US
Practice Address - Phone:925-399-5796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22654225XP0200X
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician