Provider Demographics
NPI:1649227984
Name:RYAN, ANGELE (MD)
Entity Type:Individual
Prefix:
First Name:ANGELE
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1520 SAN PABLO ST
Mailing Address - Street 2:SUITE 3451
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-5310
Mailing Address - Country:US
Mailing Address - Phone:323-442-7400
Mailing Address - Fax:323-442-7411
Practice Address - Street 1:1500 SAN PABLO ST
Practice Address - Street 2:USC UNIVERSITY HOSPITAL
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5313
Practice Address - Country:US
Practice Address - Phone:323-442-7400
Practice Address - Fax:323-442-7411
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2011-09-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG28482208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G284820328OtherCALOPTIMA
CA050089594OtherRAILROAD MEDICARE
CA00G284820OtherBLUE SHIELD
CA00G284820Medicaid
CA00G284820OtherBLUE SHIELD
CA050089594OtherRAILROAD MEDICARE