Basic Information
| Provider Information | |||||||||
| NPI: | 1275651580 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRYANT | ||||||||
| FirstName: | SHAWNA | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 E ALMOND AVE | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928662105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624376717 | ||||||||
| FaxNumber: | 5624375072 | ||||||||
| Practice Location | |||||||||
| Address1: | 456 ELM AVE | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908022426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624376717 | ||||||||
| FaxNumber: | 5624375072 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | X | Other Service Providers | Case Manager/Care Coordinator | 225CA2400X | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor | Assistive Technology Practitioner |
No ID Information.