MEDICARE: BRYAN RAZO FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	226505	AZ
2	363LF0000X	Family Nurse Practitioner	226505	AZ

General Provider Information

NPI Number	:	1184351579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN RAZO FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 8691
Second Line	:
City	:	SAN LUIS
State	:	AZ
Zip	:	85349-6832
Country	:	US
Telephone Number	:	928-750-4006
Fax Number	:

Provider Business Practice Location Address
First Line	:	1922 E CESAR CHAVEZ BLVD
Second Line	:	SUITE 7
City	:	SAN LUIS
State	:	AZ
Zip	:	85336
Country	:	US
Telephone Number	:	928-750-4006
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2022
Last Update Date	:	05/13/2026

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Directions to “ BRYAN RAZO FNP-C” Practice Location

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