Healthcare Provider Details

I. General information

NPI: 1861617060
Provider Name (Legal Business Name): NANCY JONES BRYANT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13847 E 14TH ST STE 110
SAN LEANDRO CA
94578-2625
US

IV. Provider business mailing address

PO BOX 10935
PLEASANTON CA
94588-0935
US

V. Phone/Fax

Practice location:
  • Phone: 510-357-5566
  • Fax:
Mailing address:
  • Phone: 510-357-5566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License NumberC50530
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: