Provider Demographics
NPI:1295334944
Name:CARDIA, BREANNA MARIE
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:MARIE
Last Name:CARDIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6897 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1640
Mailing Address - Country:US
Mailing Address - Phone:888-505-1773
Mailing Address - Fax:
Practice Address - Street 1:6897 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1640
Practice Address - Country:US
Practice Address - Phone:888-505-1637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician