Provider Demographics
NPI:1447001078
Name:HARDING, DEREK BRET
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:BRET
Last Name:HARDING
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 1:1371 N 390 E
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-9162
Mailing Address - Country:US
Mailing Address - Phone:925-334-0483
Mailing Address - Fax:
Practice Address - Street 1:2880 N TENAYA WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0618
Practice Address - Country:US
Practice Address - Phone:702-962-9546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program