Healthcare Provider Details

I. General information

NPI: 1164368999
Provider Name (Legal Business Name): MARY ANNE BRYCE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 MANCHESTER AVE STE 101
ENCINITAS CA
92024-4940
US

IV. Provider business mailing address

4405 MANCHESTER AVE STE 101
ENCINITAS CA
92024-4940
US

V. Phone/Fax

Practice location:
  • Phone: 760-350-9320
  • Fax: 760-650-4057
Mailing address:
  • Phone: 760-350-9320
  • Fax: 760-650-4057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN95040432
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN95040432
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License NumberRN95040432
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License NumberRN95040432
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: