Provider Demographics
NPI:1174731640
Name:BRILEY, DENNIS WAYNE (PA)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:WAYNE
Last Name:BRILEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:100 E VALENCIA MESA DR STE 105
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 E VALENCIA MESA DR
Practice Address - Street 2:SUITE 105
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3813
Practice Address - Country:US
Practice Address - Phone:714-446-5200
Practice Address - Fax:714-446-5292
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA16196363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP53388Medicare UPIN