Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | A117409 | CA |
N | 2081S0010X | Sports Medicine | A117409 | CA |
N | 213ES0000X | Sports Medicine | A117409 | CA |
NPI | 1548468267 |
---|---|
Provider Name | Dr. Manijeh Ryan |
First Address | Walnut Creek, CA 94598 |
Second Address | Sacramento, CA 95827-2544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2007 |
Last Update Date | 30/12/2020 |