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General NPI Number Information
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NPI Number | 1962617332
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Entity Type | Organization
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Legal Business Name | BRYAN CASSIM DOO, M.D., A MEDICAL CORPORATION
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 08/04/2011
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Provider Practice Location Address
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Address Line | 9209 COLIMA RD SUITE 4500
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City | WHITTIER
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State | CA
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Zip | 90605-1800
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Country | US
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Telephone | 951-278-5590
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Fax | 951-272-9924
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Provider Business Mailing Address
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Address Line | P.O. BOX 77790
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City | CORONA
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State | CA
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Zip | 92877-0126
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Country | US
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Telephone | 951-278-5590
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Fax | 951-272-9924
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRYAN CASSIM DOO
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Credential | M.D.
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Telephone | 951-278-5590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | A65648
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License Number State | CA
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