Provider Demographics
NPI:1174889562
Name:BRAZIL, LETICIA YVONNE (MILITARY PROVIDER)
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:YVONNE
Last Name:BRAZIL
Suffix:
Gender:F
Credentials:MILITARY PROVIDER
Other - Prefix:
Other - First Name:LETICIA
Other - Middle Name:YVONNE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PARAMEDIC
Mailing Address - Street 1:207 SW T HWY
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64061-9229
Mailing Address - Country:US
Mailing Address - Phone:940-704-8099
Mailing Address - Fax:
Practice Address - Street 1:331 SIJAN AVE.
Practice Address - Street 2:
Practice Address - City:WHITEMAN AFB
Practice Address - State:MO
Practice Address - Zip Code:65305-5001
Practice Address - Country:US
Practice Address - Phone:940-704-8099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAM5025933146L00000X
1710I1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic