Leticia Yvonne Brazil, MILITARY PROVIDER
Individual provider Active NPI Independent Duty Medical Technicians · Whiteman Afb, MO
NPI 1174889562 · NPPES record last updated Feb 17, 2022
Key facts
- NPI
- 1174889562
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Independent Duty Medical Technicians 1710I1003X
- Practice address
- 331 Sijan Ave.
Whiteman Afb, MO 65305-5001 - Phone
- (940) 704-8099
- NPI assigned
- Apr 10, 2012
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M5025933 | GA | MD | Paramedic |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Paramedic | 146L00000X | M5025933 | GA | |
| Independent Duty Medical Technicians | 1710I1003X | Yes |
Addresses
Primary practice location
331 Sijan Ave.
Whiteman Afb, MO 65305-5001
Mailing address
207 SW T Hwy
Kingsville, MO 64061-9229
Phone (940) 704-8099
Other names
- Leticia Yvonne Martin
Other providers in Whiteman Afb, MO
- Erik Berger
- Jason Robert Bingham
- Lucas Abinadi Bohannan
- Angela Faith Boone
- Djoanna Marie Boyd
- Whitney Nicole Brooks
- Brittney Broshous
- Sarah D Burden
- Christopher J Button
- Samantha Cecile Campbell
All providers in Whiteman Afb, MO · Independent Duty Medical Technicians in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 17, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.