Provider Demographics
NPI:1750363966
Name:BRANDT, JUDITH (DO, FAAFP)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:
Last Name:BRANDT
Suffix:
Gender:F
Credentials:DO, FAAFP
Other - Prefix:
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Mailing Address - Street 1:3070 CAMINO HEIGHTS DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:CAMINO
Mailing Address - State:CA
Mailing Address - Zip Code:95709-9508
Mailing Address - Country:US
Mailing Address - Phone:530-647-9762
Mailing Address - Fax:530-647-1961
Practice Address - Street 1:3070 CAMINO HEIGHTS DR STE B
Practice Address - Street 2:
Practice Address - City:CAMINO
Practice Address - State:CA
Practice Address - Zip Code:95709-9508
Practice Address - Country:US
Practice Address - Phone:530-651-2000
Practice Address - Fax:530-647-1961
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6245207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM08909FMedicaid
CA058909Medicare Oscar/Certification
CAF38385Medicare UPIN