Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 825008 | NV |
NPI | 1033757711 |
---|---|
Provider Name | Brandon Rey Martinez |
First Address | Las Vegas, NV 89148-4297 |
Second Address | Las Vegas, NV 89146-1144 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2019 |
Last Update Date | 13/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MM5630682 | DEA# (01) |