Provider Demographics
NPI:1811177553
Name:TRYTHALL, MICHAEL RYAN (AUD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RYAN
Last Name:TRYTHALL
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 ALESSANDRO PL STE 360
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3105
Mailing Address - Country:US
Mailing Address - Phone:626-314-3733
Mailing Address - Fax:626-314-3735
Practice Address - Street 1:50 ALESSANDRO PL STE 360
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3105
Practice Address - Country:US
Practice Address - Phone:626-314-3733
Practice Address - Fax:626-314-3735
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY57002452231H00000X
IL147001450237600000X
CAHA5049237600000X
CAAU2225237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9165139Medicaid
CAAU2225OtherCALIFORNIA SPEECH-LANGUAGE PATHOLOGY, AUDIOLOGY AND HEARING AID DISPENSERS BOARD