Provider Demographics
NPI:1568615375
Name:RYAN, MARC PIERSON (LAC)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:PIERSON
Last Name:RYAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3300
Mailing Address - Country:US
Mailing Address - Phone:310-831-2202
Mailing Address - Fax:
Practice Address - Street 1:150 W 6TH ST
Practice Address - Street 2:#200
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3300
Practice Address - Country:US
Practice Address - Phone:310-831-2202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9282171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist