Healthcare Provider Details

I. General information

NPI: 1922902022
Provider Name (Legal Business Name): CORINA GARCIA BRISENO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 N SACATON ST
CASA GRANDE AZ
85122-4431
US

IV. Provider business mailing address

112 N SACATON ST
CASA GRANDE AZ
85122-4431
US

V. Phone/Fax

Practice location:
  • Phone: 520-414-9112
  • Fax:
Mailing address:
  • Phone: 520-414-9112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-14914
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: