Provider Demographics
NPI:1063854016
Name:HAYWARD, BRANDON
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:HAYWARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 W BONANZA RD
Mailing Address - Street 2:STE L
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4774
Mailing Address - Country:US
Mailing Address - Phone:702-613-8775
Mailing Address - Fax:702-349-0041
Practice Address - Street 1:2401 W BONANZA RD
Practice Address - Street 2:STE L
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4774
Practice Address - Country:US
Practice Address - Phone:702-613-8775
Practice Address - Fax:702-349-0041
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner