Provider Demographics
NPI:1831842806
Name:PAGE, RYAN WALKER
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:WALKER
Last Name:PAGE
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 1:1457 1/2 RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-4774
Mailing Address - Country:US
Mailing Address - Phone:919-260-4015
Mailing Address - Fax:
Practice Address - Street 1:9777 WILSHIRE BLVD STE 1007
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1901
Practice Address - Country:US
Practice Address - Phone:310-461-4148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty