Provider Demographics
NPI:1649394636
Name:RYAN, GERRI LYNN (LM, CPM)
Entity Type:Individual
Prefix:MS
First Name:GERRI
Middle Name:LYNN
Last Name:RYAN
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 S WORTHINGTON ST SPC 120
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-6344
Mailing Address - Country:US
Mailing Address - Phone:619-434-9188
Mailing Address - Fax:858-278-2943
Practice Address - Street 1:15644 POMERADO RD STE 302
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2455
Practice Address - Country:US
Practice Address - Phone:858-278-2930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM 162176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20-1137486OtherEIN