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General NPI Number Information
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NPI Number | 1710106489
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Entity Type | Organization
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Legal Business Name | BROCA LIFE OPTIONS LLC
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 06/02/2010
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Provider Practice Location Address
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Address Line | 1492 S MILL AVE STE. 114
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City | TEMPE
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State | AZ
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Zip | 85281-5652
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Country | US
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Telephone | 480-557-5710
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Fax | 480-557-5712
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Provider Business Mailing Address
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Address Line | 3941 E CHANDLER BLVD STE. 106-158
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City | PHOENIX
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State | AZ
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Zip | 85048-0301
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Country | US
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Telephone | 480-557-5710
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Fax | 480-557-5712
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. L EMILY BROWN CABEZUDO
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Credential | PHD
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Telephone | 480-557-5710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 3576
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License Number State | AZ
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