1235173253 NPI number — DR. JULIE H. BRYSON M.D.

Table of content: BERNADETTE LIMIADI WALERYSZAK FNP-C (NPI 1023803632)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235173253 NPI number — DR. JULIE H. BRYSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRYSON
Provider First Name:
JULIE
Provider Middle Name:
H.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235173253
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35379 CABRINI DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YUCAIPA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92399-4817
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-442-3321
Provider Business Mailing Address Fax Number:
907-442-7250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 E MOUNTAIN VIEW ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARSTOW
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92311-3053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-442-3321
Provider Business Practice Location Address Fax Number:
907-442-7250
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  A64881 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: A64881 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: M-1599 , registered in the state of GU ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HS19OP , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: A64881 . This is a "BLUE CROSS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A648810 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HS19IP , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00A648810 . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A648810 . This is a "CALOPTIMA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 050608CH02571 . This is a "DELANO TRAILBLAZER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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