MEDICARE: BRYAN WARREN

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1134645054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN WARREN

Provider Business Mailing Address
First Line	:	13152 GREEN VIOLET DR
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33579-7214
Country	:	US
Telephone Number	:	704-451-5138
Fax Number	:

Provider Business Practice Location Address
First Line	:	13152 GREEN VIOLET DR
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33579-7214
Country	:	US
Telephone Number	:	704-451-5138
Fax Number	:

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

Provider Enumeration Date	:	08/22/2017
Last Update Date	:	08/22/2017

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Directions to “ BRYAN WARREN ” Practice Location

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