Provider Demographics
NPI:1356214324
Name:DALPORTO, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:DALPORTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14425 KINGS CT
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-1749
Mailing Address - Country:US
Mailing Address - Phone:510-259-8123
Mailing Address - Fax:
Practice Address - Street 1:14425 KINGS CT
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1749
Practice Address - Country:US
Practice Address - Phone:510-259-8123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0000405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional