Provider Demographics
NPI:1639392319
Name:STERN, BRYAN J (L AC)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:J
Last Name:STERN
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 ANACONDA LN
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4312
Mailing Address - Country:US
Mailing Address - Phone:760-943-7848
Mailing Address - Fax:
Practice Address - Street 1:2115 ANACONDA LN
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4312
Practice Address - Country:US
Practice Address - Phone:760-943-7848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 3486171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist