Provider Demographics
NPI:1760680813
Name:BIALA, REEZA BRION (PNP)
Entity Type:Individual
Prefix:
First Name:REEZA
Middle Name:BRION
Last Name:BIALA
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 COCHRAN AVE
Mailing Address - Street 2:APT 108
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036
Mailing Address - Country:US
Mailing Address - Phone:917-689-9878
Mailing Address - Fax:
Practice Address - Street 1:1403 WEST LOMITA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710
Practice Address - Country:US
Practice Address - Phone:310-784-5800
Practice Address - Fax:310-530-9811
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA600443163W00000X
CA16744363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse