Provider Demographics
NPI:1275845901
Name:RYAN, WESLEY CHRISTOPHER (MD)
Entity Type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:CHRISTOPHER
Last Name:RYAN
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 1:4519 ADMIRALTY WAY STE 202
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5428
Mailing Address - Country:US
Mailing Address - Phone:424-272-0774
Mailing Address - Fax:424-291-8944
Practice Address - Street 1:4519 ADMIRALTY WAY STE 202
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5428
Practice Address - Country:US
Practice Address - Phone:424-272-0774
Practice Address - Fax:424-291-8944
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1181342084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry