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Individual

BRYAN MOTA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1800 MEDICAL CENTER DR, SUITE 99, SAN BERNARDINO, CA 92411-1218
(909) 880-6400
Mailing address
15842 ATHOL ST, FONTANA, CA 92335-4478

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
51622
CA

Other

Enumeration date
07/15/2014
Last updated
11/18/2014
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