Provider Demographics
NPI:1457641979
Name:DABU, BRANDON
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:DABU
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 1:5524 S FORT APACHE RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-7668
Mailing Address - Country:US
Mailing Address - Phone:702-664-9614
Mailing Address - Fax:
Practice Address - Street 1:5524 S. FORT APACHE RD.
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-7668
Practice Address - Country:US
Practice Address - Phone:702-664-9614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35648167G00000X
NV876341363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No167G00000XNursing Service ProvidersLicensed Psychiatric Technician