Provider Demographics
NPI:1295117174
Name:RYAN, STEVEN
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:RYAN
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 1:1947 N CALIFORNIA ST
Mailing Address - Street 2:B
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-6029
Mailing Address - Country:US
Mailing Address - Phone:209-463-0870
Mailing Address - Fax:209-463-1003
Practice Address - Street 1:1947 N CALIFORNIA ST
Practice Address - Street 2:B
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6029
Practice Address - Country:US
Practice Address - Phone:209-463-0870
Practice Address - Fax:209-463-1903
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00-85-020-0517171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator