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General NPI Number Information
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NPI Number | 1043414535
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Entity Type | Individual
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Provider Name | ALISSA BREKKEN MD
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Gender | Female
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 04/07/2021
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Provider Practice Location Address
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Address Line | 10401 ANDERSON MILL RD STE 110B
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City | AUSTIN
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State | TX
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Zip | 78750-2579
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Country | US
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Telephone | 512-250-5571
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Fax | 512-331-0960
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Provider Business Mailing Address
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Address Line | 6210 E HIGHWAY 290 STE 240
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City | AUSTIN
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State | TX
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Zip | 78723-1144
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Country | US
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Telephone | 512-483-9596
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Fax | 512-406-6216
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4301096703
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | P7398
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License Number State | TX
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