MEDICARE: BRILLIANT SURGICAL ASSISTING

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	246ZC0007X	Surgical Assistant

General Provider Information

NPI Number	:	1518822493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRILLIANT SURGICAL ASSISTING

Provider Business Mailing Address
First Line	:	24634 N 40TH LN
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85310-5109
Country	:	US
Telephone Number	:	480-977-8440
Fax Number	:	480-977-8440

Provider Business Practice Location Address
First Line	:	24634 N 40TH LN
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85310-5109
Country	:	US
Telephone Number	:	480-977-8440
Fax Number	:	480-977-8440

Authorized Official
Title or Position	:	CSFA
Name	:	EMMA LEE BIRDEN
Credential	:	CSFA
Telephone Number	:	480-977-8440

Provider Enumeration Date	:	12/22/2025
Last Update Date	:	12/22/2025

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Directions to “BRILLIANT SURGICAL ASSISTING ” Practice Location

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