Provider Demographics
NPI:1598837676
Name:ABEL, BRYAN (LAC)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:ABEL
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1176
Mailing Address - Street 2:
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007-7176
Mailing Address - Country:US
Mailing Address - Phone:760-436-7999
Mailing Address - Fax:760-436-3993
Practice Address - Street 1:984 MONUMENT ST STE 204
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3859
Practice Address - Country:US
Practice Address - Phone:760-436-7999
Practice Address - Fax:760-436-3993
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9886171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist