Provider Demographics
NPI:1790491140
Name:MULLENBACH, BRIAN RAY (DNP, CRNA)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:RAY
Last Name:MULLENBACH
Suffix:
Gender:M
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10384 COOK RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-3021
Mailing Address - Country:US
Mailing Address - Phone:210-900-5508
Mailing Address - Fax:
Practice Address - Street 1:18220 STATE HIGHWAY 249
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4347
Practice Address - Country:US
Practice Address - Phone:281-737-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1108876367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered