Provider Demographics
NPI:1245470541
Name:BRYANT, LUDIVINA (9/13/2007 1/8/2008)
Entity type:Individual
Prefix:MRS
First Name:LUDIVINA
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:9/13/2007 1/8/2008
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 W. SUNSET RD. #2B
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209
Mailing Address - Country:US
Mailing Address - Phone:210-835-8319
Mailing Address - Fax:830-714-4222
Practice Address - Street 1:332 W SUNSET RD STE 2B
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1755
Practice Address - Country:US
Practice Address - Phone:210-835-8319
Practice Address - Fax:830-714-4222
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies