Provider Demographics
NPI:1962055426
Name:DUNN, BRYAN C (MA, CHT)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:C
Last Name:DUNN
Suffix:
Gender:M
Credentials:MA, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11650 CHIMAYO RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-7700
Mailing Address - Country:US
Mailing Address - Phone:760-985-8270
Mailing Address - Fax:
Practice Address - Street 1:12180 RIDGECREST RD STE 508
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5903
Practice Address - Country:US
Practice Address - Phone:760-985-8270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83-4587092222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist