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NPI Code Detail

MEDICARE: BRIANA CLAMANCHIE BOLIVAR

MEDICARE: BRIANA CLAMANCHIE BOLIVAR
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1871313411
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIANA CLAMANCHIE BOLIVAR
Provider Business Mailing Address
First Line : 397 SW RAY AVE
Second Line :
City : PORT SAINT LUCIE
State : FL
Zip : 34983-3047
Country : US
Telephone Number : 561-506-1935
Fax Number :
Provider Business Practice Location Address
First Line : 3200 S UNIVERSITY DR
Second Line :
City : DAVIE
State : FL
Zip : 33328-2018
Country : US
Telephone Number : 954-262-4550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2024
Last Update Date : 10/16/2024

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Directions to “ BRIANA CLAMANCHIE BOLIVAR ” Practice Location

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