Provider Demographics
NPI:1023758455
Name:SEAN RYAN, M.D., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SEAN RYAN, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-622-0622
Mailing Address - Street 1:9404 GENESEE AVE STE 335
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1355
Mailing Address - Country:US
Mailing Address - Phone:858-622-0622
Mailing Address - Fax:949-587-1142
Practice Address - Street 1:9404 GENESEE AVE STE 335
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1355
Practice Address - Country:US
Practice Address - Phone:858-622-0622
Practice Address - Fax:949-587-1142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)