Bryant, Tawanna J

Bryant, Tawanna J is an individual health care provider with primary practice located at 400 N Pepper Ave Dept.General Surgery Mod 3, Colton CA 92324-1801. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Surgical, which is considered as her primary health care specialty. Bryant, Tawanna J can be contacted via phone (909) 580-6210.

Contact Information

Primary practice address
400 N Pepper Ave Dept.General Surgery Mod 3 Colton CA 92324-1801
Phone: (909) 580-6210
Fax: (909) 580-1363
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA19573 California

Profile Details

NPI number 1508035270
LBN Legal business name Bryant, Tawanna J
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 26th, 2008
Last updated Nov 29th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508035270 NPPES
California MEDICAID GR0079700

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