Healthcare Provider Details

I. General information

NPI: 1386960441
Provider Name (Legal Business Name): RYAN S LABOVITCH MD INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27372 ALISO CREEK RD STE 200
ALISO VIEJO CA
92656-5339
US

IV. Provider business mailing address

1310 S CENTRAL AVE
GLENDALE CA
91204-2506
US

V. Phone/Fax

Practice location:
  • Phone: 949-520-1012
  • Fax: 949-520-1045
Mailing address:
  • Phone: 818-579-2408
  • Fax: 818-579-2373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA81975
License Number StateCA

VIII. Authorized Official

Name: DR. RYAN SCOTT LABOVITCH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 949-720-1944