Provider Demographics
NPI:1114703188
Name:CANTOS, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:CANTOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2772 JOHNSON DR STE 114
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7261
Mailing Address - Country:US
Mailing Address - Phone:805-644-3311
Mailing Address - Fax:805-644-2161
Practice Address - Street 1:2772 JOHNSON DR STE 114
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7261
Practice Address - Country:US
Practice Address - Phone:805-644-3311
Practice Address - Fax:805-644-2161
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027027363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily