Provider Demographics
NPI:1598761504
Name:BRIONES, JUAN MANUEL (PA C)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:MANUEL
Last Name:BRIONES
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 W SESAME DR
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-9289
Mailing Address - Country:US
Mailing Address - Phone:956-423-8042
Mailing Address - Fax:956-423-2907
Practice Address - Street 1:707 W SESAME DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-9289
Practice Address - Country:US
Practice Address - Phone:956-423-8042
Practice Address - Fax:956-423-2907
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03250363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP53661Medicare UPIN
TX8F0522Medicare PIN