Provider Demographics
NPI:1255725222
Name:BRITO, JACQUELYN (MD)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:BRITO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:945 S MESA HILLS DR APT 3704
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5157
Mailing Address - Country:US
Mailing Address - Phone:714-454-1224
Mailing Address - Fax:
Practice Address - Street 1:2625 MCNUTT RD
Practice Address - Street 2:
Practice Address - City:SUNLAND PARK
Practice Address - State:NM
Practice Address - Zip Code:88063-9608
Practice Address - Country:US
Practice Address - Phone:575-589-0887
Practice Address - Fax:575-589-0898
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2023-1497207Q00000X
TXR8870207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine