Provider Demographics
NPI:1962218032
Name:HAMANN, RYAN PATRICK (PA)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:PATRICK
Last Name:HAMANN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:PATRICK
Other - Last Name:HAMANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:16001 PERSIMMON CRK
Mailing Address - Street 2:
Mailing Address - City:JONES
Mailing Address - State:OK
Mailing Address - Zip Code:73049-8889
Mailing Address - Country:US
Mailing Address - Phone:405-818-3626
Mailing Address - Fax:
Practice Address - Street 1:1950 3RD ST
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-4401
Practice Address - Country:US
Practice Address - Phone:909-593-3511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty