Provider Demographics
NPI:1114568433
Name:PARRA, RYAN (SUDRC #11570)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:PARRA
Suffix:
Gender:M
Credentials:SUDRC #11570
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 N DOUTY ST
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-3951
Mailing Address - Country:US
Mailing Address - Phone:559-583-9300
Mailing Address - Fax:
Practice Address - Street 1:311 N DOUTY ST
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3951
Practice Address - Country:US
Practice Address - Phone:559-583-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11570101YA0400X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)