Healthcare Provider Details

I. General information

NPI: 1255641304
Provider Name (Legal Business Name): MR. ALAN DYBNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1533 EUCLID ST
SANTA MONICA CA
90404-3306
US

IV. Provider business mailing address

4420 FINLEY AVE
LOS ANGELES CA
90027-2735
US

V. Phone/Fax

Practice location:
  • Phone: 310-451-9747
  • Fax:
Mailing address:
  • Phone: 323-667-2037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: