Provider Demographics
NPI:1184102899
Name:BURRA, BRYAN
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:BURRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:PETER
Other - Middle Name:BRYAN
Other - Last Name:BURRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15335 MORRISON ST STE 320
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-6709
Mailing Address - Country:US
Mailing Address - Phone:818-856-0143
Mailing Address - Fax:818-436-4671
Practice Address - Street 1:15335 MORRISON ST STE 320
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-6709
Practice Address - Country:US
Practice Address - Phone:818-856-0143
Practice Address - Fax:818-436-4671
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician