Healthcare Provider Details

I. General information

NPI: 1184451312
Provider Name (Legal Business Name): BRIANA MESSAMORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20000 N 57TH AVENUE BLDG E UNIT 108
GLENDALE AZ
85308
US

IV. Provider business mailing address

20000 N 57TH AVENUE BLDG E UNIT 108
GLENDALE AZ
85308
US

V. Phone/Fax

Practice location:
  • Phone: 623-633-3914
  • Fax:
Mailing address:
  • Phone: 623-633-3914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code174V00000X
TaxonomyClinical Ethicist
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: