Healthcare Provider Details

I. General information

NPI: 1326972043
Provider Name (Legal Business Name): BRYN SOVACOOL
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 ROCK SPRINGS RD
SAN MARCOS CA
92069-3220
US

IV. Provider business mailing address

1020 CRIMSON DR
SAN MARCOS CA
92069-1192
US

V. Phone/Fax

Practice location:
  • Phone: 760-688-6607
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number684161
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: