Provider Demographics
NPI:1952183733
Name:HWA, BRANDON V
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:V
Last Name:HWA
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 1:8363 ALEXIA CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-4065
Mailing Address - Country:US
Mailing Address - Phone:916-479-6623
Mailing Address - Fax:
Practice Address - Street 1:8363 ALEXIA CT
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-4065
Practice Address - Country:US
Practice Address - Phone:916-479-6623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer