Provider Demographics
NPI:1235173253
Name:BRYSON, JULIE H (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:H
Last Name:BRYSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35379 CABRINI DR
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-4817
Mailing Address - Country:US
Mailing Address - Phone:907-442-3321
Mailing Address - Fax:907-442-7250
Practice Address - Street 1:801 E MOUNTAIN VIEW ST
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-3053
Practice Address - Country:US
Practice Address - Phone:907-442-3321
Practice Address - Fax:907-442-7250
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64881207P00000X, 207Q00000X
GUM-1599207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHS19OPMedicaid
CAA64881OtherBLUE CROSS
CA00A648810Medicaid
AKHS19IPMedicaid
CA00A648810OtherBLUE SHIELD
CA00A648810OtherCALOPTIMA
CA050608CH02571OtherDELANO TRAILBLAZER
CA00A648810OtherCALOPTIMA
CA00A648815Medicare ID - Type UnspecifiedDELANO REGIONAL MED CTR
CA00A648816Medicare Oscar/Certification
CAA64881OtherBLUE CROSS
CA050608CH02571OtherDELANO TRAILBLAZER