1679031447 NPI number — RYAN FRANCIS GUERCIO

Table of content: RYAN FRANCIS GUERCIO (NPI 1679031447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679031447 NPI number — RYAN FRANCIS GUERCIO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUERCIO
Provider First Name:
RYAN
Provider Middle Name:
FRANCIS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1679031447
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17233 N HOLMES BLVD
Provider Second Line Business Mailing Address:
STE 1650
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85053-2030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-547-1836
Provider Business Mailing Address Fax Number:
602-547-2806

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 SOLAR DR STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXNARD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93036-2602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-765-4773
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/11/2019

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: 261QP2000X , with the licence number:  2019006569 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: LPT-30671 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP2000X , with the licence number: 296422 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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