Provider Demographics
NPI:1841037595
Name:BIXBY, BRIANA (COTA/L)
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:
Last Name:BIXBY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:962 BAYVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-4066
Mailing Address - Country:US
Mailing Address - Phone:707-771-1777
Mailing Address - Fax:
Practice Address - Street 1:962 BAYVIEW AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-4066
Practice Address - Country:US
Practice Address - Phone:707-771-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5300208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty