MEDICARE: MELWIDA BRYANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	190008FN	CA

General Provider Information

NPI Number	:	1023375268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELWIDA BRYANT

Provider Business Mailing Address
First Line	:	4445 BURNS AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-2702
Country	:	US
Telephone Number	:	323-664-8940
Fax Number	:	323-664-1786

Provider Business Practice Location Address
First Line	:	4445 BURNS AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-2702
Country	:	US
Telephone Number	:	323-664-8940
Fax Number	:	323-664-1786

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2012
Last Update Date	:	01/20/2017

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Directions to “ MELWIDA BRYANT ” Practice Location

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