Provider Demographics
NPI:1306681275
Name:BRICENO PARRA, ANTONIO (NP)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:BRICENO PARRA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11447 MANZANO VISTA AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-2975
Mailing Address - Country:US
Mailing Address - Phone:407-990-3828
Mailing Address - Fax:
Practice Address - Street 1:8417 WASHINGTON PL NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1720
Practice Address - Country:US
Practice Address - Phone:505-273-9453
Practice Address - Fax:505-503-1619
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM55814363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily