Healthcare Provider Details

I. General information

NPI: 1871224857
Provider Name (Legal Business Name): RYAN MARONI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9482 CALIFORNIA CITY BLVD
CALIFORNIA CITY CA
93505-2803
US

IV. Provider business mailing address

1118 RAHN LOOP
EDWARDS CA
93523-2802
US

V. Phone/Fax

Practice location:
  • Phone: 760-373-5268
  • Fax:
Mailing address:
  • Phone: 928-899-3283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: