Provider Demographics
NPI:1396470175
Name:RAZAL, NEIL RYAN
Entity type:Individual
Prefix:
First Name:NEIL RYAN
Middle Name:
Last Name:RAZAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W 8TH ST APT 4606
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-5964
Mailing Address - Country:US
Mailing Address - Phone:818-370-2184
Mailing Address - Fax:
Practice Address - Street 1:15455 SAN FERNANDO MISSION BLVD STE 301
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1353
Practice Address - Country:US
Practice Address - Phone:818-869-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019950363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily