| Doctor Name: | BRANDON J CORNEJO |
| NPI Number: | 1053576082 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD, PH.D. |
| License Number: | 54982-020 |
| Business Practice Address: | 3550 North Interstate Ave. Kaiser Permanente - Interstate Medical Office East Portland, OR - 972271106 |
| Business Phone Number: | 5032859321 |
| Business Fax Number: | |
| Mailing Address: | 3550 North Interstate Ave., Kaiser Permanente Interstate Office East PORTLAND |
| State: | OR |
| Postal Code: | 972271106 |
| Phone Number: | 5032859321 |
| Fax Number: | |
| NPI Enumeration Date: | 07/18/2008 |
| NPI Last Update Date: | 07/12/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 54982-020 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |