Provider Demographics
NPI:1265832950
Name:NOLAN, RYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:NOLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:65 NEILSON ST STE 102
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-2491
Mailing Address - Country:US
Mailing Address - Phone:831-768-6266
Mailing Address - Fax:831-768-6219
Practice Address - Street 1:65 NEILSON ST STE 125
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2491
Practice Address - Country:US
Practice Address - Phone:831-768-6266
Practice Address - Fax:831-768-6219
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA161287208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery