MEDICARE: BRIANA RAYNOR

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
1	235Z00000X	Speech-Language Pathologist	11056	CA

General Provider Information

NPI Number	:	1851849632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANA RAYNOR

Provider Business Mailing Address
First Line	:	3033 THREE SPRINGS DR
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-5552
Country	:	US
Telephone Number	:	818-519-5084
Fax Number	:

Provider Business Practice Location Address
First Line	:	3033 THREE SPRINGS DR
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-5552
Country	:	US
Telephone Number	:	818-519-5084
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2016
Last Update Date	:	09/21/2016

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Directions to “ BRIANA RAYNOR ” Practice Location

Language	Start Address	Practice Location

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