Healthcare Provider Details

I. General information

NPI: 1588922561
Provider Name (Legal Business Name): RYAN D WELLS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2012
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 LAS POSAS RD SUITE 17
CAMARILLO CA
93010-1501
US

IV. Provider business mailing address

3901 LAS POSAS RD SUITE 17
CAMARILLO CA
93010-1501
US

V. Phone/Fax

Practice location:
  • Phone: 805-388-2068
  • Fax: 805-484-7700
Mailing address:
  • Phone: 805-388-2068
  • Fax: 805-484-7700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RYAN D. WELLS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 210-347-6715