Provider Demographics
NPI:1356221915
Name:BRILLANTES, DOREEN
Entity type:Individual
Prefix:
First Name:DOREEN
Middle Name:
Last Name:BRILLANTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8369 OLD FREDERICK RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-1913
Mailing Address - Country:US
Mailing Address - Phone:202-854-0316
Mailing Address - Fax:202-484-0534
Practice Address - Street 1:8369 OLD FREDERICK RD
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-1913
Practice Address - Country:US
Practice Address - Phone:202-854-0316
Practice Address - Fax:202-484-0534
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty