Provider Demographics
NPI:1013348580
Name:RYAN, GWENDOLYN JEAN (MS)
Entity Type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:JEAN
Last Name:RYAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 SANTA ANITA STREET
Mailing Address - Street 2:SUITE 338
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1160
Mailing Address - Country:US
Mailing Address - Phone:626-282-9250
Mailing Address - Fax:626-282-9953
Practice Address - Street 1:207 SANTA ANITA STREET
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1160
Practice Address - Country:US
Practice Address - Phone:626-282-9250
Practice Address - Fax:626-282-9953
Is Sole Proprietor?:No
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC000324170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS