Healthcare Provider Details

I. General information

NPI: 1700778057
Provider Name (Legal Business Name): DYLAN WAYNE ABERNATHY M.M., MT-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21515 HAWTHORNE BLVD STE GL-100
TORRANCE CA
90503-6501
US

IV. Provider business mailing address

8525 CEDAR ST
BELLFLOWER CA
90706-6368
US

V. Phone/Fax

Practice location:
  • Phone: 424-571-2618
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: