Provider Demographics
NPI:1780617308
Name:BRIDGET R. BRIGGS, M.D. INC.
Entity type:Organization
Organization Name:BRIDGET R. BRIGGS, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-791-1111
Mailing Address - Street 1:25470 MEDICAL CENTER DR
Mailing Address - Street 2:102
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-4900
Mailing Address - Country:US
Mailing Address - Phone:951-698-6090
Mailing Address - Fax:951-302-2552
Practice Address - Street 1:25470 MEDICAL CENTER DR
Practice Address - Street 2:102
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-4900
Practice Address - Country:US
Practice Address - Phone:951-698-6090
Practice Address - Fax:951-302-2552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69362207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A693621Medicare PIN
CAH69362Medicare UPIN
CAZZZ02412ZMedicare PIN