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NPI Code Detail

MEDICARE: BRYAN RAZO FNP-C

MEDICARE: BRYAN RAZO FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WP0200XPediatric Registered Nurse226505AZ
2363LF0000XFamily Nurse Practitioner226505AZ

General Provider Information

NPI Number : 1184351579
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRYAN RAZO FNP-C
Provider Business Mailing Address
First Line : PO BOX 617
Second Line :
City : SOMERTON
State : AZ
Zip : 85350-0617
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1896 E BABBIT LN
Second Line :
City : SAN LUIS
State : AZ
Zip : 85336-7820
Country : US
Telephone Number : 928-722-6112
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2022
Last Update Date : 08/13/2024

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Directions to “ BRYAN RAZO FNP-C” Practice Location

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