Healthcare Provider Details

I. General information

NPI: 1801572516
Provider Name (Legal Business Name): BRISA LLAMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 E PINE KNOLL DR
FLAGSTAFF AZ
86011-0001
US

IV. Provider business mailing address

7235 E SPOUSE DR APT B
PRESCOTT VALLEY AZ
86314-6626
US

V. Phone/Fax

Practice location:
  • Phone: 928-523-5122
  • Fax:
Mailing address:
  • Phone: 928-533-4555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: