Healthcare Provider Details

I. General information

NPI: 1194523936
Provider Name (Legal Business Name): RYAN RAYMOND MORITZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9775 VERNON AVE
MONTCLAIR CA
91763-2947
US

IV. Provider business mailing address

950 W D ST
ONTARIO CA
91762-3026
US

V. Phone/Fax

Practice location:
  • Phone: 909-624-5036
  • Fax:
Mailing address:
  • Phone: 909-459-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: