Healthcare Provider Details

I. General information

NPI: 1336526649
Provider Name (Legal Business Name): RYAN TOTH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date: 12/30/2019
Reactivation Date: 02/19/2020

III. Provider practice location address

PO BOX 1814
BENICIA CA
94510-4814
US

IV. Provider business mailing address

PO BOX 1814
BENICIA CA
94510-4814
US

V. Phone/Fax

Practice location:
  • Phone: 408-416-3775
  • Fax:
Mailing address:
  • Phone: 408-416-3775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number104478
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: