Healthcare Provider Details

I. General information

NPI: 1952374209
Provider Name (Legal Business Name): LEERA M BRICENO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEERA SETALSINGH

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 03/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 ROCHE BROS WAY SUITE 200
NORTH EASTON MA
02356-1032
US

IV. Provider business mailing address

31 ROCHE BROS WAY SUITE 200
NORTH EASTON MA
02356-1032
US

V. Phone/Fax

Practice location:
  • Phone: 508-535-3376
  • Fax: 508-535-3377
Mailing address:
  • Phone: 508-535-3376
  • Fax: 508-535-3377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number76086
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number76086
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: