Healthcare Provider Details

I. General information

NPI: 1255267522
Provider Name (Legal Business Name): BRYAN INES
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E HELLMAN AVE
ALHAMBRA CA
91801-5716
US

IV. Provider business mailing address

501 E HELLMAN AVE
ALHAMBRA CA
91801-5716
US

V. Phone/Fax

Practice location:
  • Phone: 626-943-6720
  • Fax:
Mailing address:
  • Phone: 626-943-6720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number230076182
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: