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General NPI Number Information
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NPI Number | 1093017279
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Entity Type | Individual
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Provider Name | BRIANNE ENEGREN PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/22/2010
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 5725 RALSTON ST STE 101
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City | VENTURA
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State | CA
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Zip | 93003-6053
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Country | US
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Telephone | 805-658-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 13775 SWIFT RUN ST
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City | MOORPARK
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State | CA
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Zip | 93021-1282
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Country | US
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Telephone | 805-558-8585
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA21229
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License Number State | CA
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