Provider Demographics
NPI:1548259401
Name:BRAND, JONATHAN L (MD)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:L
Last Name:BRAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4570
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES PENINSULA
Mailing Address - State:CA
Mailing Address - Zip Code:90274-9607
Mailing Address - Country:US
Mailing Address - Phone:424-400-7748
Mailing Address - Fax:424-400-7749
Practice Address - Street 1:3630 E IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2609
Practice Address - Country:US
Practice Address - Phone:310-900-8662
Practice Address - Fax:424-400-7749
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG500452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA120523OtherLA CO MENTAL HEALTH
CA00G500451Medicaid
A92950Medicare UPIN
CA00G500451Medicaid
CACB235352Medicare UPIN