Provider Demographics
NPI:1639360449
Name:RYAN, JARLATH N (MD)
Entity Type:Individual
Prefix:DR
First Name:JARLATH
Middle Name:N
Last Name:RYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:946 N BRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2905
Mailing Address - Country:US
Mailing Address - Phone:818-662-7000
Mailing Address - Fax:818-662-7131
Practice Address - Street 1:946 N BRAND BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2905
Practice Address - Country:US
Practice Address - Phone:818-662-7000
Practice Address - Fax:818-662-7131
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93342174400000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA93342OtherMEDICAL LICENSE
CAWA93342AMedicare PIN
CAB58259Medicare UPIN
CAA93342OtherMEDICAL LICENSE