Provider Demographics
NPI:1093286882
Name:BRYAN, VINCENT DANIEL
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:DANIEL
Last Name:BRYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 N TUSTIN AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-8688
Mailing Address - Country:US
Mailing Address - Phone:657-900-1948
Mailing Address - Fax:
Practice Address - Street 1:1401 N TUSTIN AVE STE 225
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8688
Practice Address - Country:US
Practice Address - Phone:657-900-1948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health