Healthcare Provider Details

I. General information

NPI: 1700607132
Provider Name (Legal Business Name): BRADEN KRISTIAN SIO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8670 W CHEYENNE AVE STE 110
LAS VEGAS NV
89129-7457
US

IV. Provider business mailing address

8670 W CHEYENNE AVE STE 110
LAS VEGAS NV
89129-7457
US

V. Phone/Fax

Practice location:
  • Phone: 725-202-1497
  • Fax: 725-202-1500
Mailing address:
  • Phone: 725-202-1497
  • Fax: 725-202-1500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT24386384
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: