Basic Information
| Provider Information | |||||||||
| NPI: | 1740858299 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORDON | ||||||||
| FirstName: | BRANDON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | APCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 535 RICHEY ST APT 204 | ||||||||
| Address2: | |||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928796181 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573532937 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 22445 ALESSANDRO BLVD # 113-114 | ||||||||
| Address2: | |||||||||
| City: | MORENO VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925538358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9519249791 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2021 | ||||||||
| LastUpdateDate: | 06/11/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | APCC7712 | CA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | APCC7712 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | APCC7712 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.