Provider Demographics
NPI:1932132339
Name:BRYANTBRUCE, CHERYL D (MD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:D
Last Name:BRYANTBRUCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHERYL
Other - Middle Name:DENISE
Other - Last Name:BRYANT-BRUCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:26335 CARMEL RANCHO BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923-8876
Mailing Address - Country:US
Mailing Address - Phone:831-625-6000
Mailing Address - Fax:831-625-6001
Practice Address - Street 1:26335 CARMEL RANCHO BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-8876
Practice Address - Country:US
Practice Address - Phone:831-625-6000
Practice Address - Fax:831-625-6001
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86766207Q00000X
TXM0675207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G867660Medicaid
F47914Medicare UPIN
CA00G867660Medicaid