Provider Demographics
NPI:1366721649
Name:BRIZUELA, MARCOS F (HEALTH EDUCATOR)
Entity type:Individual
Prefix:
First Name:MARCOS
Middle Name:F
Last Name:BRIZUELA
Suffix:
Gender:M
Credentials:HEALTH EDUCATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 FLORENCE ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-1313
Mailing Address - Country:US
Mailing Address - Phone:508-410-5387
Mailing Address - Fax:
Practice Address - Street 1:25 FLORENCE ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-1313
Practice Address - Country:US
Practice Address - Phone:508-410-5387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1301071OtherGROUP #