Provider Demographics
NPI:1063639102
Name:BUCHMANN, RYAN (MA, MFT, CADC-II)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:BUCHMANN
Suffix:
Gender:M
Credentials:MA, MFT, CADC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 W WASHINGTON ST STE 2-204
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1946
Mailing Address - Country:US
Mailing Address - Phone:760-566-8760
Mailing Address - Fax:760-820-2461
Practice Address - Street 1:325 W WASHINGTON ST STE 2-204
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-1946
Practice Address - Country:US
Practice Address - Phone:760-566-8760
Practice Address - Fax:760-820-2461
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA019280715101YA0400X
CAMFC 50774106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7560841Medicaid