Healthcare Provider Details

I. General information

NPI: 1669528667
Provider Name (Legal Business Name): VICTORIA DEANNA BRILL L.AC, LMP, RC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 4TH AVE SUITE #1322
SEATTLE WA
98101-2249
US

IV. Provider business mailing address

1411 4TH AVE SUITE #1322
SEATTLE WA
98101-2249
US

V. Phone/Fax

Practice location:
  • Phone: 206-623-1630
  • Fax:
Mailing address:
  • Phone: 206-623-1630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00000461
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: