MEDICARE: PAULINE BRANDON MA

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1912328550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULINE BRANDON MA

Provider Business Mailing Address
First Line	:	5623 VASSAR MEADOW ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-7652
Country	:	US
Telephone Number	:	702-748-1230
Fax Number	:

Provider Business Practice Location Address
First Line	:	5623 VASSAR MEADOW ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-7652
Country	:	US
Telephone Number	:	702-748-1230
Fax Number	:

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

Provider Enumeration Date	:	12/29/2013
Last Update Date	:	12/29/2013

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Directions to “ PAULINE BRANDON MA” Practice Location

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