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NPI Code Detail

MEDICARE: MR. TIMOTHY C BRYSON JR.

MEDICARE: MR. TIMOTHY C BRYSON JR.
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
1390200000XStudent in an Organized Health Care Education/Training Program
2101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1952829160
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TIMOTHY C BRYSON JR.
Provider Business Mailing Address
First Line : 6244 EL CAJON BLVD STE 15-17
Second Line :
City : SAN DIEGO
State : CA
Zip : 92115-3918
Country : US
Telephone Number : 619-287-8225
Fax Number :
Provider Business Practice Location Address
First Line : 1011 CAMINO DEL RIO S STE 300
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-3567
Country : US
Telephone Number : 619-287-8225
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2017
Last Update Date : 09/09/2024

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