Provider Demographics
NPI:1164471769
Name:GINI, RYAN (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:GINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5542 LONGLEY LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-1886
Mailing Address - Country:US
Mailing Address - Phone:775-321-1044
Mailing Address - Fax:775-853-4277
Practice Address - Street 1:5542 LONGLEY LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-1886
Practice Address - Country:US
Practice Address - Phone:775-321-1044
Practice Address - Fax:775-853-4277
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9483207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016777Medicaid
NVAQ416ZOtherMEDICARE PTAN
NVP00959137OtherMEDICARE RR PTAN