Individual
BRANDON LEE NATHANIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
26520 CACTUS AVE, MORENO VALLEY, CA 92555-3927
(951) 486-5700
(951) 486-5705
Mailing address
PO BOX 7270, MORENO VALLEY, CA 92552-7270
(951) 656-1500
(951) 656-1510
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
A112673
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CA124033
PTAN
CA
Enumeration date
06/05/2008
Last updated
06/19/2019
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