MEDICARE: NBBA

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
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1336029925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NBBA

Provider Business Mailing Address
First Line	:	10210 N 92ND ST STE 104
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-4531
Country	:	US
Telephone Number	:	480-493-0900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1560 BROADWAY STE 1600
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-5160
Country	:	US
Telephone Number	:	480-493-0900
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRITTANY TREVINO-GOMBAR
Credential	:	FNP
Telephone Number	:	623-295-1190

Provider Enumeration Date	:	09/04/2025
Last Update Date	:	09/04/2025

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