Provider Demographics
NPI:1578227609
Name:HEMBREE, RYAN MICHAEL (IDC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:MICHAEL
Last Name:HEMBREE
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3523 N OXNARD BLVD
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-5480
Mailing Address - Country:US
Mailing Address - Phone:904-612-1439
Mailing Address - Fax:
Practice Address - Street 1:NAV MOB CONST BATT 5
Practice Address - Street 2:2600 DODSON ST STE 3
Practice Address - City:PORT HUENEME
Practice Address - State:CA
Practice Address - Zip Code:93043-4432
Practice Address - Country:US
Practice Address - Phone:805-989-3315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
Provider Identifiers
StateIdentifier IDID TypeIssuer
1105810721OtherDOD ID