Healthcare Provider Details

I. General information

NPI: 1396126637
Provider Name (Legal Business Name): BRISAS MARIE FLORES TRUNCALI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 SOUTH RD STE 100
FARMINGTON CT
06032-2482
US

IV. Provider business mailing address

21 SOUTH RD STE 100
FARMINGTON CT
06032-2482
US

V. Phone/Fax

Practice location:
  • Phone: 860-409-4567
  • Fax: 860-409-4846
Mailing address:
  • Phone: 860-409-4567
  • Fax: 860-409-4846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number264179
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number264179
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: