Provider Demographics
NPI:1619015401
Name:RYAN, JOSEPH KEVIN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:KEVIN
Last Name:RYAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1266 W VAQUERO CT
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-8132
Mailing Address - Country:US
Mailing Address - Phone:619-216-2506
Mailing Address - Fax:
Practice Address - Street 1:1266 W VAQUERO CT
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-8132
Practice Address - Country:US
Practice Address - Phone:619-216-2506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant