Provider Demographics
NPI:1003607854
Name:DILTS, BRYAN C
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:C
Last Name:DILTS
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 1:1515 HUGHES WAY
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90810-1865
Mailing Address - Country:US
Mailing Address - Phone:562-997-8000
Mailing Address - Fax:
Practice Address - Street 1:1515 HUGHES WAY
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90810-1865
Practice Address - Country:US
Practice Address - Phone:562-997-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool