MEDICARE: BRILLIANCY CLINICAL RESEARCH LLC

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	1744R1102X	Research Study Specialist

General Provider Information

NPI Number	:	1811618218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRILLIANCY CLINICAL RESEARCH LLC

Provider Business Mailing Address
First Line	:	12955 SW 42ND ST STE 2
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-2928
Country	:	US
Telephone Number	:	786-491-4947
Fax Number	:	305-364-5711

Provider Business Practice Location Address
First Line	:	12955 SW 42ND ST STE 2
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-2928
Country	:	US
Telephone Number	:	786-491-4947
Fax Number	:	305-364-5711

Authorized Official
Title or Position	:	P
Name	:	GLEYS J PEREZ
Credential	:
Telephone Number	:	786-491-4947

Provider Enumeration Date	:	09/06/2022
Last Update Date	:	09/06/2022

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