Provider Information for 1841441029
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BRANDON SHAPOOR PORSANDEH
Sex: Male
NPI: 1841441029
Last Updated: 2016-12-12
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1841441029 | ||||||||||||
| Enumeration Date | 2008-10-06 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 100 W BROADWAY LONG BEACH, CA 90802-4431 United States Phone: 562-243-6492 | Fax: | ||||||||||||
| Primary Practice Address | 100 W BROADWAY LONG BEACH, CA 90802-4431 United States Phone: 562-243-6492 | Fax: | ||||||||||||
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