Most Relevant Information
Provider Data
| NPI Number: | 1003508052 |
| Provider Name: | KHADIJA LANAE BRYANT |
| Entity Type: | Individual |
| Taxonomy Code: | 172V00000X |
| Specialty: | Community Health Worker |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/25/2023 |
| Last Updated: | 06/13/2024 |
Provider Practice Location
4892 SAN PABLO DAM RD
EL SOBRANTE
CA
948033222
Practice Location Phone/Fax
| Phone: | 5102432360 |
| Fax: |
Provider Mailing Location
8945 GOLF LINKS RD
OAKLAND
CA
946054124
Provider Mailing Phone/Fax
| Phone: | 5103171444 |
| Fax: |