Provider Demographics
NPI:1801037692
Name:VITALI, RYAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:S
Last Name:VITALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:151 N SUNRISE AVE
Mailing Address - Street 2:STE 1103
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2931
Mailing Address - Country:US
Mailing Address - Phone:916-472-6566
Mailing Address - Fax:
Practice Address - Street 1:151 N SUNRISE AVE
Practice Address - Street 2:STE 1103
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2931
Practice Address - Country:US
Practice Address - Phone:916-782-1217
Practice Address - Fax:916-782-7630
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA106700207X00000X
AZ46228207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA104418Medicare UPIN