1245471853 NPI number — BRYNA ELIZABETH FLORENCE PHYSICIAN ASSISTANT

Table of content: BRYNA ELIZABETH FLORENCE PHYSICIAN ASSISTANT (NPI 1245471853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245471853 NPI number — BRYNA ELIZABETH FLORENCE PHYSICIAN ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLORENCE
Provider First Name:
BRYNA
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHYSICIAN ASSISTANT
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:
1245471853
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6645 ALVARADO ROAD
Provider Second Line Business Mailing Address:
SUITE 415
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-229-4941
Provider Business Mailing Address Fax Number:
619-229-4950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6645 ALVARADO RD
Provider Second Line Business Practice Location Address:
SUITE 415
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92120-5208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-261-9000
Provider Business Practice Location Address Fax Number:
619-229-4950
Provider Enumeration Date:
03/11/2009

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: 363AM0700X , with the licence number:  PA20232 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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