Healthcare Provider Details

I. General information

NPI: 1063988178
Provider Name (Legal Business Name): RACHEL RAE DELFINO BRILES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 E BEVERLY AVE STE 203
KINGMAN AZ
86409-3593
US

IV. Provider business mailing address

1308 N STOCKTON HILL RD STE A
KINGMAN AZ
86401-5190
US

V. Phone/Fax

Practice location:
  • Phone: 928-757-3133
  • Fax:
Mailing address:
  • Phone: 928-279-1686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP11780
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: