Individual
BRYAN DE JUSTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1235 MCHENRY AVE, SUITE #A & #B, MODESTO, CA 95350
(209) 527-4597
Mailing address
2704 MEDINAH WAY, MODESTO, CA 95355-9619
(408) 888-4587
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
09/07/2023
Last updated
09/07/2023
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