Provider Demographics
NPI:1639839061
Name:HEREDIA, BRIHIANA MARIE
Entity Type:Individual
Prefix:
First Name:BRIHIANA
Middle Name:MARIE
Last Name:HEREDIA
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 1:1820 E SAHARA AVE STE 114
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3736
Mailing Address - Country:US
Mailing Address - Phone:702-262-1202
Mailing Address - Fax:702-749-6232
Practice Address - Street 1:1820 E SAHARA AVE STE 114
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3736
Practice Address - Country:US
Practice Address - Phone:702-262-1202
Practice Address - Fax:702-749-6232
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant