Individual
BRANDON ALLEN DEHAVEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1360 N MAIN ST, BISHOP, CA 93514-3013
(760) 872-2590
Mailing address
1360 N MAIN ST, BISHOP, CA 93514-3013
(760) 872-2590
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
05/26/2023
Last updated
05/26/2023
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