Healthcare Provider Details

I. General information

NPI: 1902261985
Provider Name (Legal Business Name): JUDITH BRINN CPHE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2015
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7362 REMCON CIR
EL PASO TX
79912-1623
US

IV. Provider business mailing address

108 ISABELLA DR
EL PASO TX
79912-4502
US

V. Phone/Fax

Practice location:
  • Phone: 915-820-7731
  • Fax:
Mailing address:
  • Phone: 915-820-7731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: