MEDICARE: BRANDON HAYWARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225400000X	Rehabilitation Practitioner		NV

General Provider Information

NPI Number	:	1063854016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON HAYWARD

Provider Business Mailing Address
First Line	:	2401 W BONANZA RD
Second Line	:	STE L
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4774
Country	:	US
Telephone Number	:	702-613-8775
Fax Number	:	702-349-0041

Provider Business Practice Location Address
First Line	:	2401 W BONANZA RD
Second Line	:	STE L
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4774
Country	:	US
Telephone Number	:	702-613-8775
Fax Number	:	702-349-0041

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2013
Last Update Date	:	07/18/2013

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Directions to “ BRANDON HAYWARD ” Practice Location

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