Healthcare Provider Details

I. General information

NPI: 1043128804
Provider Name (Legal Business Name): BRYAN ALTON GIVENS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 NEVADA ST
AUBURN CA
95603-3720
US

IV. Provider business mailing address

6560 HEARTHSTONE CIR APT 1213
ROCKLIN CA
95677-4630
US

V. Phone/Fax

Practice location:
  • Phone: 530-886-5800
  • Fax:
Mailing address:
  • Phone: 831-682-4889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number36866
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: