Provider Demographics
NPI:1073195244
Name:RAINNEY, BRIELLE DAMIANA (LM, CPM)
Entity type:Individual
Prefix:MRS
First Name:BRIELLE
Middle Name:DAMIANA
Last Name:RAINNEY
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1856 RAYMOND AVE
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-2618
Mailing Address - Country:US
Mailing Address - Phone:760-571-9918
Mailing Address - Fax:
Practice Address - Street 1:1856 RAYMOND AVE
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-2618
Practice Address - Country:US
Practice Address - Phone:760-571-9918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA635175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay