Healthcare Provider Details

I. General information

NPI: 1114389491
Provider Name (Legal Business Name): RYAN LORENO LYM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 GIRARD AVE STE 106
LA JOLLA CA
92037-5138
US

IV. Provider business mailing address

3880 MURPHY CANYON RD STE 200
SAN DIEGO CA
92123-4411
US

V. Phone/Fax

Practice location:
  • Phone: 858-459-4351
  • Fax: 858-459-4399
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA152493
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: