Healthcare Provider Details

I. General information

NPI: 1265322879
Provider Name (Legal Business Name): BRANDON HAWRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: B.HAWARA H. M.S. MD

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 BARTLETT LN
SACRAMENTO CA
95815-3694
US

IV. Provider business mailing address

1555 BARTLETT LN
SACRAMENTO CA
95815-3694
US

V. Phone/Fax

Practice location:
  • Phone: 916-277-9578
  • Fax:
Mailing address:
  • Phone: 916-277-9578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number5CP6QAJQ7D6722J8V7XE
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA54247380
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: