Healthcare Provider Details

I. General information

NPI: 1316721335
Provider Name (Legal Business Name): RYAN FARQUHAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S GRAND AVE
LOS ANGELES CA
90015-3010
US

IV. Provider business mailing address

1401 S GRAND AVE
LOS ANGELES CA
90015-3010
US

V. Phone/Fax

Practice location:
  • Phone: 213-748-2411
  • Fax:
Mailing address:
  • Phone: 213-748-2411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA63970
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberPA63970
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: