Provider Demographics
NPI:1508859828
Name:BRIONES, JOSE CABRERA JR (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:CABRERA
Last Name:BRIONES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:130 W ROUTE 66
Mailing Address - Street 2:#202
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-6249
Mailing Address - Country:US
Mailing Address - Phone:626-914-4705
Mailing Address - Fax:626-852-0331
Practice Address - Street 1:130 W ROUTE 66
Practice Address - Street 2:#202
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-6249
Practice Address - Country:US
Practice Address - Phone:626-914-4705
Practice Address - Fax:626-852-0331
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC40152207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C401520Medicaid
CAW8302Medicare ID - Type Unspecified
CA00C401520Medicaid