Healthcare Provider Details

I. General information

NPI: 1427769488
Provider Name (Legal Business Name): LAQUEL JANEY BRIGGINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 12/12/2022
Certification Date: 12/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9895 ALAMEDA AVE
SOCORRO TX
79927-2956
US

IV. Provider business mailing address

2044 SHADOW RIDGE DR
EL PASO TX
79938-4626
US

V. Phone/Fax

Practice location:
  • Phone: 347-757-8269
  • Fax:
Mailing address:
  • Phone: 347-757-8269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: