Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | A73951 | CA |
N | 207ND0101X | MOHS-Micrographic Surgeon | A73951 | CA |
N | 207ND0900X | Dermatopathologist | A73951 | CA |
N | 207NS0135X | Procedural Dermatology | A73951 | CA |
NPI | 1184697658 |
---|---|
Provider Name | Dr. Ryan D Wells |
First Address | Camarillo, CA 93010-1501 |
Second Address | Camarillo, CA 93010-1501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 30/04/2012 |