Provider Demographics
NPI:1942734504
Name:RYAN, ALISON
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 TAYLOR BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2163
Mailing Address - Country:US
Mailing Address - Phone:925-677-5041
Mailing Address - Fax:925-677-5027
Practice Address - Street 1:400 TAYLOR BLVD STE 202
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2163
Practice Address - Country:US
Practice Address - Phone:925-677-5041
Practice Address - Fax:925-677-5027
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54405363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant