MEDICARE: DIANA RUTH BRYANT MD

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	207R00000X	Internal Medicine Physician	G62214	CA

General Provider Information

NPI Number	:	1255425146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA RUTH BRYANT MD

Provider Business Mailing Address
First Line	:	1777 N BELLFLOWER BLVD STE 201
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-4020
Country	:	US
Telephone Number	:	562-961-9991
Fax Number	:	562-961-9891

Provider Business Practice Location Address
First Line	:	1777 N BELLFLOWER BLVD STE 201
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-4020
Country	:	US
Telephone Number	:	562-961-9991
Fax Number	:	562-961-9891

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	04/19/2018

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