Provider Demographics
NPI:1952110199
Name:BENNETT, BRANDON EDWARD
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:EDWARD
Last Name:BENNETT
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 1:4383 GIBRALTAR DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-4749
Mailing Address - Country:US
Mailing Address - Phone:925-577-1152
Mailing Address - Fax:
Practice Address - Street 1:4383 GIBRALTAR DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-4749
Practice Address - Country:US
Practice Address - Phone:925-577-1152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA014700223374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide