Provider Demographics
NPI:1851072227
Name:DE LA MERCED, RYAN MICHAEL
Entity Type:Individual
Prefix:
First Name:RYAN MICHAEL
Middle Name:
Last Name:DE LA MERCED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:
Other - Last Name:DE LA MERCED
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1786 PLAZA DEL AMO APT 1
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-4507
Mailing Address - Country:US
Mailing Address - Phone:310-408-6890
Mailing Address - Fax:
Practice Address - Street 1:1786 PLAZA DEL AMO APT 1
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-4507
Practice Address - Country:US
Practice Address - Phone:310-408-6890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA844686163W00000X
CA95002171367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse