Provider Demographics
NPI:1962640391
Name:BRYAN, DANIEL WILLIAM (N/A)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:WILLIAM
Last Name:BRYAN
Suffix:
Gender:M
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2038 N VENTURA AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-1309
Mailing Address - Country:US
Mailing Address - Phone:805-647-1777
Mailing Address - Fax:805-653-6776
Practice Address - Street 1:2038 N VENTURA AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-1309
Practice Address - Country:US
Practice Address - Phone:805-647-1777
Practice Address - Fax:805-653-6776
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAR100992245332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies