Provider Demographics
NPI:1003914318
Name:LABOVITCH, RYAN S (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:S
Last Name:LABOVITCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1401 AVOCADO AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7720
Mailing Address - Country:US
Mailing Address - Phone:949-720-1944
Mailing Address - Fax:949-720-9710
Practice Address - Street 1:1401 AVOCADO AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7720
Practice Address - Country:US
Practice Address - Phone:949-720-1944
Practice Address - Fax:949-720-9710
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA81975207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI638891Medicare UPIN