Provider Demographics
NPI:1285941898
Name:DUNNIGAN, RYAN GAVIN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:GAVIN
Last Name:DUNNIGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:RYAN
Other - Middle Name:G
Other - Last Name:DUNNIGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD, MA, MBA
Mailing Address - Street 1:183 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-1518
Mailing Address - Country:US
Mailing Address - Phone:415-720-2663
Mailing Address - Fax:
Practice Address - Street 1:3270 KERNER BLVD STE A
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-4840
Practice Address - Country:US
Practice Address - Phone:415-473-2681
Practice Address - Fax:415-473-5850
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27458103TF0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program