Provider Demographics
NPI:1316073455
Name:BRYAN, WASHINGTON II (MD)
Entity type:Individual
Prefix:DR
First Name:WASHINGTON
Middle Name:
Last Name:BRYAN
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11669 SANTA MONICA BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2929
Mailing Address - Country:US
Mailing Address - Phone:310-228-3652
Mailing Address - Fax:310-499-4177
Practice Address - Street 1:11669 SANTA MONICA BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2929
Practice Address - Country:US
Practice Address - Phone:310-228-3652
Practice Address - Fax:310-499-4177
Is Sole Proprietor?:No
Enumeration Date:2007-02-25
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61799207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A617991Medicaid
CAH45246Medicare UPIN
CA00A617991Medicaid