Healthcare Provider Details

I. General information

NPI: 1780293332
Provider Name (Legal Business Name): BRIANNE MARIE ORTIZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6848 MAGNOLIA AVE STE 125
RIVERSIDE CA
92506-2899
US

IV. Provider business mailing address

1843 LEXINGTON DR
CORONA CA
92878-3683
US

V. Phone/Fax

Practice location:
  • Phone: 951-289-9512
  • Fax: 951-394-8438
Mailing address:
  • Phone: 951-858-5616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95015051
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: