Provider Demographics
NPI:1396473211
Name:MARCELO BRITO MD, PCCL
Entity type:Organization
Organization Name:MARCELO BRITO MD, PCCL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARCELO
Authorized Official - Middle Name:ERNESTO
Authorized Official - Last Name:BRITO TELLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-573-7228
Mailing Address - Street 1:713 HEBRON PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-5135
Mailing Address - Country:US
Mailing Address - Phone:972-315-8588
Mailing Address - Fax:972-315-2423
Practice Address - Street 1:713 HEBRON PKWY STE 220
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-5135
Practice Address - Country:US
Practice Address - Phone:972-315-8588
Practice Address - Fax:972-315-2423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty