Provider Demographics
NPI:1386960441
Name:RYAN S LABOVITCH MD INCORPORATED
Entity type:Organization
Organization Name:RYAN S LABOVITCH MD INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:LABOVITCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-720-1944
Mailing Address - Street 1:1310 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2506
Mailing Address - Country:US
Mailing Address - Phone:818-579-2408
Mailing Address - Fax:818-579-2373
Practice Address - Street 1:27372 ALISO CREEK RD STE 200
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-5339
Practice Address - Country:US
Practice Address - Phone:949-520-1012
Practice Address - Fax:949-520-1045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81975207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty