Provider Demographics
NPI:1891722658
Name:BURNEY, BRIAN WILLIAM (CRNA)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:WILLIAM
Last Name:BURNEY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Practice Address - Street 1:850S ATLANTIC BLVD 201
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-6705
Practice Address - Country:US
Practice Address - Phone:626-289-2894
Practice Address - Fax:951-296-6741
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA2088367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANA2088Medicare ID - Type UnspecifiedNURSE ANESTHETIST