Provider Demographics
NPI:1811015175
Name:ANDERSON, RYAN CHRISTIAN (OT C)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:CHRISTIAN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:OT C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2997 GLENBROOK STREET
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-7024
Mailing Address - Country:US
Mailing Address - Phone:760-730-3545
Mailing Address - Fax:760-633-3546
Practice Address - Street 1:351 SANTA FE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5137
Practice Address - Country:US
Practice Address - Phone:760-633-3130
Practice Address - Fax:760-633-3546
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA051109207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery