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NPI Code Detail

MEDICARE: MS. ADRIA TAMISHA BRYANT

MEDICARE: MS. ADRIA TAMISHA BRYANT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1326331380
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ADRIA TAMISHA BRYANT
Provider Business Mailing Address
First Line : 3605 LONG BEACH BLVD STE 108
Second Line :
City : LONG BEACH
State : CA
Zip : 90807-4023
Country : US
Telephone Number : 714-680-8200
Fax Number : 714-680-8207
Provider Business Practice Location Address
First Line : 15233 VENTURA BLVD STE 500
Second Line :
City : SHERMAN OAKS
State : CA
Zip : 91403-2231
Country : US
Telephone Number : 877-418-2978
Fax Number : 866-500-2186
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2011
Last Update Date : 11/11/2022

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