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NPI Code Detail

MEDICARE: SEPHIRA GILLION RYMAN

MEDICARE:   SEPHIRA GILLION RYMAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103G00000XClinical NeuropsychologistPSY1641NM

General Provider Information

NPI Number : 1477140630
Entity Type Code : Individual
Provider Name (Legal Business Name) : SEPHIRA GILLION RYMAN
Provider Business Mailing Address
First Line : 800 BRADBURY DR SE STE 116
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87106-4310
Country : US
Telephone Number : 505-272-1476
Fax Number : 505-216-2623
Provider Business Practice Location Address
First Line : 1300 CENTRAL AVE SW
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87102-2805
Country : US
Telephone Number : 505-243-0335
Fax Number : 505-216-2623
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2020
Last Update Date : 10/21/2024

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Directions to “ SEPHIRA GILLION RYMAN ” Practice Location

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