Healthcare Provider Details

I. General information

NPI: 1568373801
Provider Name (Legal Business Name): BRIANNA RIDDLEBARGER, PHYSICIAN ASSISTANT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26732 CROWN VALLEY PKWY STE 443
MISSION VIEJO CA
92691-6375
US

IV. Provider business mailing address

38 VENETO LN
ALISO VIEJO CA
92656-8040
US

V. Phone/Fax

Practice location:
  • Phone: 949-200-7929
  • Fax: 949-200-7929
Mailing address:
  • Phone: 949-200-7929
  • Fax: 949-200-7929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MS. BRITTEN DEVEREUX
Title or Position: ADMINISTRATOR
Credential:
Phone: 214-306-8447