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Individual

MR. BRYCE HART MOULTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
14303-RAC

Contact information

Practice address
132 W 10TH ST, SAN PEDRO, CA 90731-3702
(310) 514-4940
Mailing address
1003 S BEACON ST, SAN PEDRO, CA 90731-4324
(310) 514-4940

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
14303-RAC
CA

Other

Enumeration date
10/27/2020
Last updated
10/27/2020
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