MEDICARE: BILLY R BRICENO PA

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	363A00000X	Physician Assistant	PA04281	TX

General Provider Information

NPI Number	:	1477551224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BILLY R BRICENO PA

Provider Business Mailing Address
First Line	:	1237 SOUTHWESTERN DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-1115
Country	:	US
Telephone Number	:	915-307-7632
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 PERSHING DR
Second Line	:	SUITE A
City	:	EL PASO
State	:	TX
Zip	:	79903-2403
Country	:	US
Telephone Number	:	915-566-9369
Fax Number	:	915-566-8120

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	07/08/2007

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