Provider Demographics
NPI:1508638750
Name:DE LAS NUECES, BRADY (MD)
Entity Type:Individual
Prefix:
First Name:BRADY
Middle Name:
Last Name:DE LAS NUECES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 STIRLING RD APT 227
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-1570
Mailing Address - Country:US
Mailing Address - Phone:954-495-0588
Mailing Address - Fax:
Practice Address - Street 1:7400 STIRLING RD APT 227
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-1570
Practice Address - Country:US
Practice Address - Phone:954-495-0588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHSE34671390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program