Provider Demographics
NPI:1952550675
Name:MCNALLY, RYAN ALEX (ND)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:ALEX
Last Name:MCNALLY
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8566 LEPUS RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-1609
Mailing Address - Country:US
Mailing Address - Phone:774-254-1873
Mailing Address - Fax:
Practice Address - Street 1:4110 SORRENTO VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1429
Practice Address - Country:US
Practice Address - Phone:203-576-4108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND711175F00000X
CA52369363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant