Provider Demographics
NPI:1871145987
Name:SORENSEN, BRANDON DANIEL
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:DANIEL
Last Name:SORENSEN
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 1:500 N CASINO CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-2944
Mailing Address - Country:US
Mailing Address - Phone:702-229-0310
Mailing Address - Fax:
Practice Address - Street 1:500 N CASINO CENTER BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-2944
Practice Address - Country:US
Practice Address - Phone:702-229-0310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV988489146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic