MEDICARE: VICTORIA BRYANT MFT

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	106H00000X	Marriage & Family Therapist	32887	CA

General Provider Information

NPI Number	:	1285948216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA BRYANT MFT

Provider Business Mailing Address
First Line	:	PO BOX 1267
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-1267
Country	:	US
Telephone Number	:	562-493-9003
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 DOLPHIN AVE APT 3
Second Line	:
City	:	SEAL BEACH
State	:	CA
Zip	:	90740-5033
Country	:	US
Telephone Number	:	562-493-9003
Fax Number	:

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

Provider Enumeration Date	:	08/02/2010
Last Update Date	:	08/02/2010

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