Healthcare Provider Details

I. General information

NPI: 1295531465
Provider Name (Legal Business Name): KAELA ZENAIDA BRYANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 EDMONDS RD
REDWOOD CITY CA
94062-3813
US

IV. Provider business mailing address

1185 HILLCREST BLVD
MILLBRAE CA
94030-2234
US

V. Phone/Fax

Practice location:
  • Phone: 650-367-1890
  • Fax: 650-369-6465
Mailing address:
  • Phone: 650-445-3113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95054472
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: