Provider Demographics
NPI:1003608274
Name:BRICENO, DANIEL ALEJANDRO
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ALEJANDRO
Last Name:BRICENO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4240 NW 107TH AVE APT 4110
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-4891
Mailing Address - Country:US
Mailing Address - Phone:786-498-3654
Mailing Address - Fax:
Practice Address - Street 1:4240 NW 107TH AVE APT 4110
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4891
Practice Address - Country:US
Practice Address - Phone:786-498-3654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician