Provider Demographics
NPI:1104385509
Name:LONGORIA, BRAULIO
Entity Type:Individual
Prefix:
First Name:BRAULIO
Middle Name:
Last Name:LONGORIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 UNION BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-6514
Mailing Address - Country:US
Mailing Address - Phone:303-989-8169
Mailing Address - Fax:303-984-4366
Practice Address - Street 1:14785 PRESTON RD STE 550
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-7899
Practice Address - Country:US
Practice Address - Phone:303-989-8169
Practice Address - Fax:303-984-4366
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst