Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | A113632 | CA |
NPI | 1093020018 |
---|---|
Provider Name | Dr. Ryan Matthew Spivak |
First Address | Los Angeles, CA 90046-0666 |
Second Address | Lynwood, CA 90262-2661 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2010 |
Last Update Date | 08/05/2018 |