Provider Demographics
NPI:1497360531
Name:BRYAN, EVAN (HHP, MT)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:BRYAN
Suffix:
Gender:M
Credentials:HHP, MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7956 CINNABAR DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-6353
Mailing Address - Country:US
Mailing Address - Phone:619-587-3517
Mailing Address - Fax:
Practice Address - Street 1:7956 CINNABAR DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-6353
Practice Address - Country:US
Practice Address - Phone:619-587-3517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty