Healthcare Provider Details

I. General information

NPI: 1104520253
Provider Name (Legal Business Name): DARREN BRAUDE, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 LAS PAREDES
CORRALES NM
87048-8402
US

IV. Provider business mailing address

366 LAS PAREDES
CORRALES NM
87048-8402
US

V. Phone/Fax

Practice location:
  • Phone: 505-220-7422
  • Fax:
Mailing address:
  • Phone: 505-220-7422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DARREN BRAUDE
Title or Position: OWNER
Credential: MD
Phone: 505-220-7422