Healthcare Provider Details

I. General information

NPI: 1992468599
Provider Name (Legal Business Name): BRIA OBRIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 S LOOP W STE 328
HOUSTON TX
77054-2886
US

IV. Provider business mailing address

2600 S LOOP W STE 328
HOUSTON TX
77054-2886
US

V. Phone/Fax

Practice location:
  • Phone: 844-622-8466
  • Fax:
Mailing address:
  • Phone: 844-622-8466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number44493286
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: