Healthcare Provider Details

I. General information

NPI: 1205022241
Provider Name (Legal Business Name): RYLAN D EAST PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6320 N LA CHOLLA BLVD STE 200
TUCSON AZ
85741
US

IV. Provider business mailing address

PO BOX 31630
TUCSON AZ
85751-1630
US

V. Phone/Fax

Practice location:
  • Phone: 520-382-8200
  • Fax: 520-297-3505
Mailing address:
  • Phone: 520-382-8200
  • Fax: 520-297-3505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number3681
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3681
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: