Provider Demographics
NPI:1568617108
Name:VIETS, RYAN B (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:B
Last Name:VIETS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7777 ALVARADO ROAD # 108
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942
Mailing Address - Country:US
Mailing Address - Phone:619-460-2770
Mailing Address - Fax:619-460-2774
Practice Address - Street 1:5555 GROSSMONT CENTER DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942
Practice Address - Country:US
Practice Address - Phone:619-740-4034
Practice Address - Fax:619-740-4324
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA1258092085R0202X
MO20120124832085R0202X
CAA151144208600000X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208600000XAllopathic & Osteopathic PhysiciansSurgery