Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A141382 | CA |
N | 111NI0900X | Internist | A141382 | CA |
Y | 207RH0003X | Hematology & Oncology | A141382 | CA |
NPI | 1013335199 |
---|---|
Provider Name | Ryan Matthew Ponec |
First Address | Los Angeles, CA 90095-7417 |
Second Address | Tarzana, CA 91356-3645 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2014 |
Last Update Date | 30/07/2021 |