Provider Demographics
NPI:1316638422
Name:BRYAN, GROVER C
Entity type:Individual
Prefix:
First Name:GROVER
Middle Name:C
Last Name:BRYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10070 PASADENA AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-5942
Mailing Address - Country:US
Mailing Address - Phone:408-746-0300
Mailing Address - Fax:408-343-1285
Practice Address - Street 1:10070 PASADENA AVE STE 2
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-5942
Practice Address - Country:US
Practice Address - Phone:408-746-0300
Practice Address - Fax:408-343-1285
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver