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NPI Code Detail

MEDICARE: PAULINE BRANDON MA

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
1103K00000XBehavior 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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