Healthcare Provider Details

I. General information

NPI: 1780081455
Provider Name (Legal Business Name): BRILLIANT CONTOURS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13402 N SCOTTSDALE RD SUITE B185, ROOM 101
SCOTTSDALE AZ
85254-4054
US

IV. Provider business mailing address

13402 N SCOTTSDALE RD SUITE B185, ROOM 101
SCOTTSDALE AZ
85254-4054
US

V. Phone/Fax

Practice location:
  • Phone: 480-607-6490
  • Fax:
Mailing address:
  • Phone: 480-607-6490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number21023370
License Number StateAZ

VIII. Authorized Official

Name: MS. JANICE TRANE JONES
Title or Position: CEO
Credential:
Phone: 480-607-6490