Provider Demographics
NPI:1063145407
Name:MEX-LOREDO, BRANDON ISAIAS (EMT)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:ISAIAS
Last Name:MEX-LOREDO
Suffix:
Gender:M
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5106 W STUART AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-3328
Mailing Address - Country:US
Mailing Address - Phone:702-771-0124
Mailing Address - Fax:
Practice Address - Street 1:2960 S CHERRY AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-5445
Practice Address - Country:US
Practice Address - Phone:717-547-1720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-04
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance