Provider Demographics
NPI:1235455767
Name:JANZEN, BYRON KEVIN
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:KEVIN
Last Name:JANZEN
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 1:21250 BOX SPRINGS RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-8705
Mailing Address - Country:US
Mailing Address - Phone:951-369-8036
Mailing Address - Fax:
Practice Address - Street 1:21250 BOX SPRINGS RD
Practice Address - Street 2:SUITE 106
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-8705
Practice Address - Country:US
Practice Address - Phone:951-369-8036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56072106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist