1720386386 NPI number — SEAN PATRICK RYAN ASRT

Table of content: SEAN PATRICK RYAN ASRT (NPI 1720386386)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720386386 NPI number — SEAN PATRICK RYAN ASRT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RYAN
Provider First Name:
SEAN
Provider Middle Name:
PATRICK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ASRT
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:
1720386386
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1655 W HORIZON RIDGE PKWY
Provider Second Line Business Mailing Address:
STE. 100
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89012-3494
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-914-2790
Provider Business Mailing Address Fax Number:
702-914-5984

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1470 E CALVADA BLVD
Provider Second Line Business Practice Location Address:
STE. 100
Provider Business Practice Location Address City Name:
PAHRUMP
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89048-3905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-537-2300
Provider Business Practice Location Address Fax Number:
775-537-2345
Provider Enumeration Date:
03/07/2011

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: 227800000X , with the licence number:  RC1879 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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