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NPI Code Detail

MEDICARE: BRANDON DECALUWE

MEDICARE: BRANDON DECALUWE
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
1207W00000XOphthalmology PhysicianA154285CA

General Provider Information

NPI Number : 1316365521
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDON DECALUWE
Provider Business Mailing Address
First Line : PO BOX 35380
Second Line :
City : LAS VEGAS
State : NV
Zip : 89133-5380
Country : US
Telephone Number : 702-579-3203
Fax Number :
Provider Business Practice Location Address
First Line : 6109 W RAMSEY ST
Second Line :
City : BANNING
State : CA
Zip : 92220-3051
Country : US
Telephone Number : 951-845-0313
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2014
Last Update Date : 12/12/2025

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Directions to “ BRANDON DECALUWE ” Practice Location

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