Provider Demographics
NPI:1023365467
Name:EHTESSABIAN, RYAN ALI (MS, CNS)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:ALI
Last Name:EHTESSABIAN
Suffix:
Gender:M
Credentials:MS, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31234 PALOS VERDES DR W
Mailing Address - Street 2:#2
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-5361
Mailing Address - Country:US
Mailing Address - Phone:310-293-0036
Mailing Address - Fax:
Practice Address - Street 1:2725 VIA VICTORIA
Practice Address - Street 2:
Practice Address - City:PALOS VERDES ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-4475
Practice Address - Country:US
Practice Address - Phone:310-293-0036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACNS #16139133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education