Provider Demographics
NPI:1992919104
Name:BRICENO, JOSE V (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:V
Last Name:BRICENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:V
Other - Last Name:BRICENO MENDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:449 KAPAHULU AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-3850
Mailing Address - Country:US
Mailing Address - Phone:808-735-0007
Mailing Address - Fax:
Practice Address - Street 1:449 KAPAHULU AVE STE 104
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-3850
Practice Address - Country:US
Practice Address - Phone:808-735-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301091019207Q00000X
FLME106477207Q00000X
HIMD-21626207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002293100Medicaid