Provider Demographics
NPI:1164007480
Name:FENDEL, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:FENDEL
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 1:8017 NORTON AVE
Mailing Address - Street 2:#303
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046
Mailing Address - Country:US
Mailing Address - Phone:310-906-6779
Mailing Address - Fax:
Practice Address - Street 1:205 HIGHLAND PL
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-2015
Practice Address - Country:US
Practice Address - Phone:310-906-6779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies