Healthcare Provider Details

I. General information

NPI: 1144583444
Provider Name (Legal Business Name): RYENN L WEST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11333 SEPULVEDA BLVD
MISSION HILLS CA
91345-1116
US

IV. Provider business mailing address

800 5TH AVE STE 9
SEATTLE WA
98104-3262
US

V. Phone/Fax

Practice location:
  • Phone: 877-634-3196
  • Fax:
Mailing address:
  • Phone: 888-227-3312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number128534
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA128534
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: