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General NPI Number Information
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NPI Number | 1518684919
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Entity Type | Organization
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Legal Business Name | BRINCA BOCA LLC
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Dates
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Enumeration Date | 10/26/2022
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Last Update Date | 10/26/2022
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Provider Practice Location Address
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Address Line | 10260 KILKENNY PL
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City | DALLAS
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State | TX
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Zip | 75228-3235
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Country | US
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Telephone | 469-694-1030
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Fax |
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Provider Business Mailing Address
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Address Line | 9540 GARLAND RD. STE 381 #255
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City | DALLAS
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State | TX
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Zip | 75218-3423
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Country | US
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Telephone | 469-694-1030
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Fax | 469-694-1030
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Authorized Official
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Title or Position | CEO
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Name | SOLEDAD GONZALEZ
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Credential | M.S., CCC-SLP
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Telephone | 469-694-1030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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