Provider Demographics
NPI:1154003317
Name:DE GARBOTT, BRITAINIE
Entity type:Individual
Prefix:
First Name:BRITAINIE
Middle Name:
Last Name:DE GARBOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4082 BELVEDERE ST
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-2211
Mailing Address - Country:US
Mailing Address - Phone:310-547-1766
Mailing Address - Fax:
Practice Address - Street 1:4082 BELVEDERE ST
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-2211
Practice Address - Country:US
Practice Address - Phone:310-547-1766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA760569367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered