Healthcare Provider Details

I. General information

NPI: 1134000284
Provider Name (Legal Business Name): BRIELLE AMBER T. SADORRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 N RANCHO DR STE 113
LAS VEGAS NV
89130-3188
US

IV. Provider business mailing address

5967 AZZURA PALMS AVE
LAS VEGAS NV
89139-6968
US

V. Phone/Fax

Practice location:
  • Phone: 702-209-3544
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: