Provider Demographics
NPI:1508287939
Name:LUVIAN, BRISA
Entity Type:Individual
Prefix:
First Name:BRISA
Middle Name:
Last Name:LUVIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 473
Mailing Address - Street 2:
Mailing Address - City:CHAMBERINO
Mailing Address - State:NM
Mailing Address - Zip Code:88027-0473
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:134 LOPEZ AVE
Practice Address - Street 2:
Practice Address - City:CHAMBERINO
Practice Address - State:NM
Practice Address - Zip Code:88027-0473
Practice Address - Country:US
Practice Address - Phone:915-329-9007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator