Provider Demographics
NPI:1154375780
Name:BRIEN, HEATHER (MD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BRIEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 HOSPITAL RD STE 227
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3523
Mailing Address - Country:US
Mailing Address - Phone:949-646-6212
Mailing Address - Fax:949-650-3013
Practice Address - Street 1:361 HOSPITAL RD STE 227
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3523
Practice Address - Country:US
Practice Address - Phone:949-646-6212
Practice Address - Fax:949-650-3013
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG614752086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG61475Medicare UPIN
CAF32529Medicare UPIN