Provider Demographics
NPI:1609209303
Name:BORIHANE, BRYANT (PHD)
Entity type:Individual
Prefix:DR
First Name:BRYANT
Middle Name:
Last Name:BORIHANE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 LEGATO CT
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-0975
Mailing Address - Country:US
Mailing Address - Phone:909-272-1619
Mailing Address - Fax:
Practice Address - Street 1:3433 LEGATO CT
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-0975
Practice Address - Country:US
Practice Address - Phone:909-272-1619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB83662871744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1102XOther Service ProvidersSpecialistResearch Study