Provider Demographics
NPI:1568762508
Name:DAVID C RYAN, M.D. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DAVID C RYAN, M.D. A MEDICAL CORPORATION
Other - Org Name:POINT LOMA FAMILY & AESTHETICS MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CLAUDE
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:619-222-2355
Mailing Address - Street 1:2931 JARVIS ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-2314
Mailing Address - Country:US
Mailing Address - Phone:619-222-2355
Mailing Address - Fax:619-222-2721
Practice Address - Street 1:2931 JARVIS ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-2314
Practice Address - Country:US
Practice Address - Phone:619-222-2355
Practice Address - Fax:619-222-2721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74922207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE47760Medicare UPIN