Provider Demographics
NPI:1851582266
Name:RYAN, SUSAN MARGARET (DPM)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARGARET
Last Name:RYAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3250 FORTUNE CT
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-7847
Mailing Address - Country:US
Mailing Address - Phone:530-823-7171
Mailing Address - Fax:530-823-7847
Practice Address - Street 1:3250 FORTUNE CT
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-7847
Practice Address - Country:US
Practice Address - Phone:530-823-7171
Practice Address - Fax:530-823-7847
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE4738213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist