Healthcare Provider Details

I. General information

NPI: 1083532279
Provider Name (Legal Business Name): ALVIN BRYANT PPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 N 2ND ST
EL CAJON CA
92021-6449
US

IV. Provider business mailing address

511 N 2ND ST
EL CAJON CA
92021-6449
US

V. Phone/Fax

Practice location:
  • Phone: 619-772-3116
  • Fax:
Mailing address:
  • Phone: 619-772-3116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number250081192
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: