Healthcare Provider Details

I. General information

NPI: 1659978948
Provider Name (Legal Business Name): BRAYAN URIEL BERUMEN LOMES DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 W CAMELBACK RD STE 101
PHOENIX AZ
85015-3483
US

IV. Provider business mailing address

9430 W OREGON AVE
GLENDALE AZ
85305-3348
US

V. Phone/Fax

Practice location:
  • Phone: 480-396-2781
  • Fax: 480-854-3094
Mailing address:
  • Phone: 480-241-1721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number31466
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: