Provider Demographics
NPI:1518605518
Name:MASSO, BRYAN JAVIER
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:JAVIER
Last Name:MASSO
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 1:105 CARDINAL AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2218
Mailing Address - Country:US
Mailing Address - Phone:956-605-7891
Mailing Address - Fax:
Practice Address - Street 1:105 CARDINAL AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2218
Practice Address - Country:US
Practice Address - Phone:956-605-7891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)