Healthcare Provider Details

I. General information

NPI: 1790137099
Provider Name (Legal Business Name): MR. BRANDON KIRCHNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 09/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 S FORT APACHE RD UNIT 1233
LAS VEGAS NV
89117-5714
US

IV. Provider business mailing address

2200 S FORT APACHE RD UNIT 1233
LAS VEGAS NV
89117-5714
US

V. Phone/Fax

Practice location:
  • Phone: 702-459-7500
  • Fax: 702-333-4480
Mailing address:
  • Phone: 702-459-7500
  • Fax: 702-333-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: