Healthcare Provider Details

I. General information

NPI: 1710106489
Provider Name (Legal Business Name): BROCA LIFE OPTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 06/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1492 S MILL AVE STE. 114
TEMPE AZ
85281-5652
US

IV. Provider business mailing address

3941 E CHANDLER BLVD STE. 106-158
PHOENIX AZ
85048-0301
US

V. Phone/Fax

Practice location:
  • Phone: 480-557-5710
  • Fax: 480-557-5712
Mailing address:
  • Phone: 480-557-5710
  • Fax: 480-557-5712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3576
License Number StateAZ

VIII. Authorized Official

Name: DR. L EMILY BROWN CABEZUDO
Title or Position: DOCTOR
Credential: PHD
Phone: 480-557-5710