Individual
LARISSA CRYSTAL BRANDOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6889 S. EASTERN AVE, LAS VEGAS, NV 89119
(702) 750-4490
Mailing address
1001 DUMONT BLVD APT 166, LAS VEGAS, NV 89169
(702) 750-4490
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
12/27/2013
Last updated
12/27/2013
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