Provider Demographics
NPI:1215011242
Name:BRIAN BURNEY, CRNA, PROFESSIONAL NURSING ANESTHESIA, INC.
Entity Type:Organization
Organization Name:BRIAN BURNEY, CRNA, PROFESSIONAL NURSING ANESTHESIA, INC.
Other - Org Name:BRIAN BURNEY, CRNA, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BURNEY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:310-547-5782
Mailing Address - Street 1:1309 W 35TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-6005
Mailing Address - Country:US
Mailing Address - Phone:310-547-5782
Mailing Address - Fax:310-547-5782
Practice Address - Street 1:1309 W 35TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-6005
Practice Address - Country:US
Practice Address - Phone:310-547-5782
Practice Address - Fax:310-547-5782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2015-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA2088367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANA2088OtherSTATE LICENSE #
CANA2088Medicare ID - Type UnspecifiedCRNA LIC.#