Healthcare Provider Details

I. General information

NPI: 1023760352
Provider Name (Legal Business Name): BRIANNA VICTORIA TAPIA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 COORS BLVD NW
ALBUQUERQUE NM
87120-1173
US

IV. Provider business mailing address

5320 VALENTINO ST NW
ALBUQUERQUE NM
87120-3596
US

V. Phone/Fax

Practice location:
  • Phone: 505-836-4899
  • Fax:
Mailing address:
  • Phone: 505-985-4440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA1189
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: