Provider Demographics
NPI:1184325078
Name:TARDI, BRANDON
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:
Last Name:TARDI
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 1:6200 N ORACLE RD APT 180
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-5468
Mailing Address - Country:US
Mailing Address - Phone:850-217-2902
Mailing Address - Fax:
Practice Address - Street 1:6200 N ORACLE RD APT 180
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5468
Practice Address - Country:US
Practice Address - Phone:850-217-2902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians