Healthcare Provider Details

I. General information

NPI: 1275007981
Provider Name (Legal Business Name): RYAN VALMORES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 N H ST
LOMPOC CA
93436-3342
US

IV. Provider business mailing address

1317 N H ST
LOMPOC CA
93436-3342
US

V. Phone/Fax

Practice location:
  • Phone: 805-735-7651
  • Fax:
Mailing address:
  • Phone: 805-735-7651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number71589
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: