Basic Information
| Provider Information | |||||||||
| NPI: | 1477647048 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRIENO | ||||||||
| FirstName: | ELSA | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 W. 34TH STREET | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123230276 | ||||||||
| FaxNumber: | 5123230279 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 W. 34TH STREET | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123230276 | ||||||||
| FaxNumber: | 5123230279 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | H6072 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1303851-04 | 05 | TX | MEDICAID |