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General NPI Number Information
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NPI Number | 1497438766
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Entity Type | Individual
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Provider Name | BRYAN ROBERTSON
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Gender | Male
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Dates
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Enumeration Date | 08/11/2023
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 6363 WILSHIRE BLVD STE 520
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City | LOS ANGELES
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State | CA
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Zip | 90048-5727
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Country | US
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Telephone | 310-866-0440
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Fax |
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Provider Business Mailing Address
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Address Line | 1522 CORTE CABALLO
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City | UPLAND
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State | CA
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Zip | 91786-5163
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Country | US
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Telephone | 714-906-1710
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 157666
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | CA
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