Provider Demographics
NPI:1790828226
Name:RYAN, RONALD JAMES (MFT)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:JAMES
Last Name:RYAN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31905 CORTE MENDOZA
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-3530
Mailing Address - Country:US
Mailing Address - Phone:951-741-4229
Mailing Address - Fax:951-506-0843
Practice Address - Street 1:28481 RANCHO CALIFORNIA RD
Practice Address - Street 2:SUITE 205A
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-3610
Practice Address - Country:US
Practice Address - Phone:951-741-4229
Practice Address - Fax:951-506-0843
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39611106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist