Provider Demographics
NPI:1629523394
Name:BENEDICTO, RYAN (FNP)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:BENEDICTO
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27022 MOUNTAIN WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91387-3991
Mailing Address - Country:US
Mailing Address - Phone:818-653-0284
Mailing Address - Fax:
Practice Address - Street 1:27022 MOUNTAIN WILLOW LN
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91387-3991
Practice Address - Country:US
Practice Address - Phone:818-653-0284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004811363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily