Provider Demographics
NPI:1750120358
Name:BRIANNA RIDDLEBARGER, PHYSICIAN ASSOCIATE, INC
Entity type:Organization
Organization Name:BRIANNA RIDDLEBARGER, PHYSICIAN ASSOCIATE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA
Authorized Official - Prefix:
Authorized Official - First Name:BRIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDDLEBARGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-306-8447
Mailing Address - Street 1:26732 CROWN VALLEY PKWY STE 443
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6375
Mailing Address - Country:US
Mailing Address - Phone:214-306-8447
Mailing Address - Fax:
Practice Address - Street 1:3421 STORY RD W
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-3571
Practice Address - Country:US
Practice Address - Phone:214-306-8447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty