Provider Demographics
NPI:1245818871
Name:PEDRO, BRYSON NOLAN
Entity type:Individual
Prefix:MR
First Name:BRYSON
Middle Name:NOLAN
Last Name:PEDRO
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 1:7 IWALANI ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-5466
Mailing Address - Country:US
Mailing Address - Phone:808-756-7731
Mailing Address - Fax:
Practice Address - Street 1:69 RAILROAD AVE STE A3
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4574
Practice Address - Country:US
Practice Address - Phone:808-935-7949
Practice Address - Fax:808-934-8318
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker