Provider Demographics
NPI:1205111481
Name:RYAN, KORI (MS)
Entity type:Individual
Prefix:
First Name:KORI
Middle Name:
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 1:8376 HERCULES ST
Mailing Address - Street 2:#2
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-2902
Mailing Address - Country:US
Mailing Address - Phone:619-667-6891
Mailing Address - Fax:
Practice Address - Street 1:8376 HERCULES ST
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-2902
Practice Address - Country:US
Practice Address - Phone:619-667-6891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program