Healthcare Provider Details

I. General information

NPI: 1851687693
Provider Name (Legal Business Name): SCOTT A BRANDON CST,CSFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 06/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1857 DERBYSHIRE DR
LAS VEGAS NV
89117-5358
US

IV. Provider business mailing address

1857 DERBYSHIRE DR
LAS VEGAS NV
89117-5358
US

V. Phone/Fax

Practice location:
  • Phone: 702-445-4166
  • Fax:
Mailing address:
  • Phone: 702-445-4166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number125635
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: