Healthcare Provider Details

I. General information

NPI: 1811484496
Provider Name (Legal Business Name): MR. ANTHONY JASPER WILLIAM BRYANT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 HOWARD ST.
SAN FRANCISCO CA
94102
US

IV. Provider business mailing address

1380 HOWARD ST.
SAN FRANCISCO CA
94102
US

V. Phone/Fax

Practice location:
  • Phone: 415-255-3788
  • Fax:
Mailing address:
  • Phone: 415-255-3737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberD3140179
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: