Provider Demographics
NPI:1982347803
Name:RYAN, JOSEPH (RD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:RYAN
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5222 SERENO DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-3042
Mailing Address - Country:US
Mailing Address - Phone:541-829-1959
Mailing Address - Fax:
Practice Address - Street 1:5222 SERENO DR
Practice Address - Street 2:
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780-3042
Practice Address - Country:US
Practice Address - Phone:541-829-1959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered