Provider Demographics
NPI:1104287531
Name:BRIETZKE, ELLA (CNA,MED TECH)
Entity type:Individual
Prefix:
First Name:ELLA
Middle Name:
Last Name:BRIETZKE
Suffix:
Gender:F
Credentials:CNA,MED TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7518 MONTE CRISTO
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78239-3607
Mailing Address - Country:US
Mailing Address - Phone:210-784-9279
Mailing Address - Fax:
Practice Address - Street 1:7518 MONTE CRISTO
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78239-3607
Practice Address - Country:US
Practice Address - Phone:210-784-9279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-12
Last Update Date:2016-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home