Provider Demographics
NPI:1588356588
Name:BRIONES, LUIS EMMANUEL D
Entity type:Individual
Prefix:
First Name:LUIS EMMANUEL
Middle Name:D
Last Name:BRIONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:LUIS EMMANUEL
Other - Middle Name:DELA CRUZ
Other - Last Name:BRIONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3530 BUCKINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-7218
Mailing Address - Country:US
Mailing Address - Phone:559-387-9103
Mailing Address - Fax:
Practice Address - Street 1:3400 FLORAL AVE
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-9036
Practice Address - Country:US
Practice Address - Phone:559-891-1960
Practice Address - Fax:559-891-1962
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87942183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist