Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | G61475 | CA |
NPI | 1154375780 |
---|---|
Provider Name | Heather Brien |
First Address | Newport Beach, CA 92663-3523 |
Second Address | Newport Beach, CA 92663-3523 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 08/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F32529 | (02) | CA |
G61475 | (02) | CA |