Provider Demographics
NPI:1932815222
Name:GHALAMBOR, BRANDON SHIRZAD (AA)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:SHIRZAD
Last Name:GHALAMBOR
Suffix:
Gender:M
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9844 RESEARCH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4381
Mailing Address - Country:US
Mailing Address - Phone:909-262-5561
Mailing Address - Fax:
Practice Address - Street 1:1709 S BANNA AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-5612
Practice Address - Country:US
Practice Address - Phone:909-262-5561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician