Healthcare Provider Details

I. General information

NPI: 1801344288
Provider Name (Legal Business Name): MR. DEVEN DWAYNE BRADEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2175 ROSALINE AVE
REDDING CA
96001-2549
US

IV. Provider business mailing address

931 LEISHA LN
REDDING CA
96001-6203
US

V. Phone/Fax

Practice location:
  • Phone: 530-225-6000
  • Fax:
Mailing address:
  • Phone: 208-861-6529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: