Basic Information
| Provider Information | |||||||||
| NPI: | 1528601572 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ORTBALS | ||||||||
| FirstName: | BRIANNA | ||||||||
| MiddleName: | |||||||||
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| Credential: | CRNA, MSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 888 N SAN MATEO DR APT B214 | ||||||||
| Address2: | |||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944012684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136361025 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 757 WESTWOOD PLZ STE 3325 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900955318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108259111 | ||||||||
| FaxNumber: | 3102673899 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2019 | ||||||||
| LastUpdateDate: | 12/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 95072883 | CA | Y | Nursing Service Providers | Registered Nurse | 163W00000X | 838362 | TX | N | Nursing Service Providers | Registered Nurse |
No ID Information.