1992944102 NPI number — MR. RYAN SACLOLO DELOS SANTOS LVN

Table of content: MR. RYAN SACLOLO DELOS SANTOS LVN (NPI 1992944102)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992944102 NPI number — MR. RYAN SACLOLO DELOS SANTOS LVN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELOS SANTOS
Provider First Name:
RYAN
Provider Middle Name:
SACLOLO
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LVN
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992944102
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16302 GARD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORWALK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90650-6911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-860-3791
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1020 S ARROYO PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91105-3911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-403-2794
Provider Business Practice Location Address Fax Number:
626-403-4898
Provider Enumeration Date:
02/11/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164X00000X , with the licence number:  VN 213495 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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