Healthcare Provider Details

I. General information

NPI: 1326594219
Provider Name (Legal Business Name): BRIANNE MEDINA RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRIANNE ALEXIS AKEMI SHOJI RN, FNP

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 WILSON TER STE 250
GLENDALE CA
91206-4075
US

IV. Provider business mailing address

20 VISTA REAL DR ROLLING HILLS ESTATES
ROLLING HILLS ESTATES CA
90274-4227
US

V. Phone/Fax

Practice location:
  • Phone: 818-246-7115
  • Fax: 877-366-1148
Mailing address:
  • Phone: 310-539-2280
  • Fax: 310-539-1188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number760321
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95004897
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: