Provider Demographics
NPI:1992541684
Name:VANDERHORST, RYLAN MARIE
Entity type:Individual
Prefix:
First Name:RYLAN
Middle Name:MARIE
Last Name:VANDERHORST
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 1:4931 LOMA LAGUNA DR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-3809
Mailing Address - Country:US
Mailing Address - Phone:760-277-4564
Mailing Address - Fax:
Practice Address - Street 1:122 CIVIC CENTER DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-6040
Practice Address - Country:US
Practice Address - Phone:760-650-4128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA144321106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist