Individual
BRYANT LUONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, OTR/L
Contact information
Practice address
500 TAMAL PLZ STE 527, CORTE MADERA, CA 94925-1187
(949) 232-5834
Mailing address
341 RIVIERA DR, SAN RAFAEL, CA 94901-1528
(949) 232-5834
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
18396
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2597222
MERCER/PROLIABILITY
CA
Enumeration date
06/08/2018
Last updated
06/08/2018
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