Provider Demographics
NPI:1477551224
Name:BRICENO, BILLY R (PA)
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:R
Last Name:BRICENO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1237 SOUTHWESTERN DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1115
Mailing Address - Country:US
Mailing Address - Phone:915-307-7632
Mailing Address - Fax:
Practice Address - Street 1:2900 PERSHING DR
Practice Address - Street 2:SUITE A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-2403
Practice Address - Country:US
Practice Address - Phone:915-566-9369
Practice Address - Fax:915-566-8120
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04281363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ29192Medicare UPIN
TX8C8837Medicare ID - Type Unspecified