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Individual

BRYAN GREEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
HEARING AID DISPENSE

Contact information

Practice address
1000 DELBON AVE STE 7, TURLOCK, CA 95382-2008
(209) 632-2213
(209) 632-2213
Mailing address
PO BOX 3090, TURLOCK, CA 95381-3090
(209) 632-2213
(209) 632-3781

Taxonomy

Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
HA1741
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
HA0017410
CA
01
ZZZ06931Z
BLUE SHIELD PROVIDER
CA
Enumeration date
01/11/2007
Last updated
07/09/2007
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