Provider Demographics
NPI:1831854231
Name:HAMILTON, BRANDON GERRY (PCC TRAINEE)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:GERRY
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:PCC TRAINEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6803 ARVERNE CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3309
Mailing Address - Country:US
Mailing Address - Phone:858-752-2952
Mailing Address - Fax:
Practice Address - Street 1:3767 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-2599
Practice Address - Country:US
Practice Address - Phone:619-278-0777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1013045905Medicaid