Provider Demographics
NPI:1225302995
Name:WADA, RYAN (PA-C)
Entity Type:Individual
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First Name:RYAN
Middle Name:
Last Name:WADA
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2100 POWELL ST
Mailing Address - Street 2:SUITE 900
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1826
Mailing Address - Country:US
Mailing Address - Phone:510-350-2673
Mailing Address - Fax:510-879-4084
Practice Address - Street 1:400 N PEPPER AVE
Practice Address - Street 2:SUITE #1M107
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1801
Practice Address - Country:US
Practice Address - Phone:909-580-2178
Practice Address - Fax:909-580-1388
Is Sole Proprietor?:No
Enumeration Date:2012-02-28
Last Update Date:2012-10-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA22150363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant