Healthcare Provider Details

I. General information

NPI: 1861921744
Provider Name (Legal Business Name): DR. JAMES BYLUND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 06/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SAND CREEK RD STE G-5
BRENTWOOD CA
94513-2124
US

IV. Provider business mailing address

756 MARJORAM DR
BRENTWOOD CA
94513-5178
US

V. Phone/Fax

Practice location:
  • Phone: 925-303-7054
  • Fax: 925-303-7054
Mailing address:
  • Phone: 925-788-9264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberB7027424
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: