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Individual

BRANDON DEDERICH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MPT, MS, ATC

Contact information

Practice address
144 W LOS ANGELES AVE STE 110, MOORPARK, CA 93021-4218
(805) 552-1915
(805) 552-1991
Mailing address
144 W LOS ANGELES AVE STE 110, MOORPARK, CA 93021-4218
(805) 552-1915
(805) 552-1991

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
26864
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
264440100
DEPT OF LABOR
CA
01
OPT268640
BLUE SHIELD INDIVIDUAL
CA
01
ZZZ082282
BLUE SHIELD GROUP#
CA
Enumeration date
03/14/2006
Last updated
08/01/2022
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