Healthcare Provider Details

I. General information

NPI: 1578520896
Provider Name (Legal Business Name): RICHARD J BRALLIAR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2445 FIRE MESA ST 270
LAS VEGAS NV
89128-9014
US

IV. Provider business mailing address

7930 W SAHARA AVE
LAS VEGAS NV
89117-1990
US

V. Phone/Fax

Practice location:
  • Phone: 702-876-9330
  • Fax: 702-876-9061
Mailing address:
  • Phone: 702-406-6758
  • Fax: 702-852-0348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number815
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: