MEDICARE: DR. RICHARD J BRALLIAR DO

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	2084P0800X	Psychiatry Physician	815	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578520896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD J BRALLIAR DO

Provider Business Mailing Address
First Line	:	7930 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1990
Country	:	US
Telephone Number	:	702-406-6758
Fax Number	:	702-852-0348

Provider Business Practice Location Address
First Line	:	2445 FIRE MESA ST
Second Line	:	270
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-9014
Country	:	US
Telephone Number	:	702-876-9330
Fax Number	:	702-876-9061

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

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	05/02/2024

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