Provider Demographics
NPI:1831375401
Name:BRIONES, CHRISTINE O (PA)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:O
Last Name:BRIONES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:BRIONES
Other - Last Name:DOUTHIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14780 W MOUNTAIN VIEW BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-7280
Mailing Address - Country:US
Mailing Address - Phone:623-374-7774
Mailing Address - Fax:623-240-1110
Practice Address - Street 1:14780 W MOUNTAIN VIEW BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374
Practice Address - Country:US
Practice Address - Phone:623-374-7774
Practice Address - Fax:623-240-1110
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4247363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ382296Medicaid
AZ382296Medicaid