Provider Demographics
NPI:1093285850
Name:BOROM, BRANDON JAMES (RDN LMT MBW BSN)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:JAMES
Last Name:BOROM
Suffix:
Gender:M
Credentials:RDN LMT MBW BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 SPARKS BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-7933
Mailing Address - Country:US
Mailing Address - Phone:775-527-7950
Mailing Address - Fax:
Practice Address - Street 1:885 SPARKS BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-7933
Practice Address - Country:US
Practice Address - Phone:775-527-7950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-04
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV86177356133VN1201X
NVNVMT.6268172M00000X, 173C00000X, 225700000X, 226300000X
NV133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No172M00000XOther Service ProvidersMechanotherapistGroup - Multi-Specialty
No173C00000XOther Service ProvidersReflexologist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapistGroup - Multi-Specialty