Healthcare Provider Details

I. General information

NPI: 1952404212
Provider Name (Legal Business Name): BRYAN P MCDADE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 EUREKA SQ UNIT 217
PACIFICA CA
94044-2654
US

IV. Provider business mailing address

80 EUREKA SQ UNIT 217
PACIFICA CA
94044-2654
US

V. Phone/Fax

Practice location:
  • Phone: 650-557-0885
  • Fax: 650-477-1506
Mailing address:
  • Phone: 650-557-0885
  • Fax: 650-477-1506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: