Provider Demographics
NPI:1689393761
Name:PARDOSI, BRANDON KEVIN (PA-C)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:KEVIN
Last Name:PARDOSI
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1150 N INDIAN CANYON DR # CA92262
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4872
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1150 N INDIAN CANYON DR # CA92262
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4872
Practice Address - Country:US
Practice Address - Phone:909-809-7148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-11-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA61943363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical