Healthcare Provider Details

I. General information

NPI: 1285513747
Provider Name (Legal Business Name): ANDREW BRYANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 08/29/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1554 WINDSHORE WAY
OXNARD CA
93035-1401
US

IV. Provider business mailing address

9040 JACKSON AVE JOINT BASE LEWIS MCCHORD
TACOMA WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 916-833-6210
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: