Healthcare Provider Details

I. General information

NPI: 1215431937
Provider Name (Legal Business Name): PATRICK RYAN MAYOCK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DR. RYAN MAYOCK

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4733 W SUNSET BLVD FL 3
LOS ANGELES CA
90027-6093
US

IV. Provider business mailing address

4733 W SUNSET BLVD FL 3
LOS ANGELES CA
90027-6093
US

V. Phone/Fax

Practice location:
  • Phone: 206-462-0659
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberA163616
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberA163616
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: