Provider Demographics
NPI:1528601572
Name:ORTBALS, BRIANNA (CRNA, MSN)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:ORTBALS
Suffix:
Gender:F
Credentials:CRNA, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 N SAN MATEO DR APT B214
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2684
Mailing Address - Country:US
Mailing Address - Phone:913-636-1025
Mailing Address - Fax:
Practice Address - Street 1:757 WESTWOOD PLZ STE 3325
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-5318
Practice Address - Country:US
Practice Address - Phone:310-825-9111
Practice Address - Fax:310-267-3899
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95072883163W00000X
TX838362163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse