Provider Demographics
NPI:1316412224
Name:GERSHENSON, RYAN (DVM, DACVECC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:GERSHENSON
Suffix:
Gender:M
Credentials:DVM, DACVECC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22123 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1649
Mailing Address - Country:US
Mailing Address - Phone:818-883-8387
Mailing Address - Fax:
Practice Address - Street 1:22123 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1649
Practice Address - Country:US
Practice Address - Phone:818-883-8387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-06
Last Update Date:2018-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17110207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine