Provider Demographics
NPI:1326018250
Name:BRYANT, LUBRINA ESTELLA (DPM)
Entity Type:Individual
Prefix:DR
First Name:LUBRINA
Middle Name:ESTELLA
Last Name:BRYANT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:LUBRINA
Other - Middle Name:ESTELLA
Other - Last Name:LOUIS-JACQUES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:1647 BENNING RD NE
Mailing Address - Street 2:200
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4570
Mailing Address - Country:US
Mailing Address - Phone:202-388-5303
Mailing Address - Fax:202-388-5305
Practice Address - Street 1:1647 BENNING RD NE
Practice Address - Street 2:SUITE 200
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4570
Practice Address - Country:US
Practice Address - Phone:202-388-5303
Practice Address - Fax:202-388-5305
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300768213E00000X
DCP01000007213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4699OtherBRAVO
0187OtherBCBS
1471929OtherAETNA
2155212OtherUNITED HEALTHCARE
T1477OtherHEALTH RIGHT
22390OtherDC CHARTERED
GA480032058OtherRAILROAD MEDICARE
DC490512OtherMEDICARE
DC4699OtherELDER HEALTH
VA480000714OtherMEDICARE
DC017242700Medicaid
VA9304151Medicaid
22390OtherDC CHARTERED
DC017242700Medicaid