Healthcare Provider Details

I. General information

NPI: 1679031447
Provider Name (Legal Business Name): RYAN FRANCIS GUERCIO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 SOLAR DR STE 204
OXNARD CA
93036-2602
US

IV. Provider business mailing address

17233 N HOLMES BLVD STE 1650
PHOENIX AZ
85053-2030
US

V. Phone/Fax

Practice location:
  • Phone: 805-765-4773
  • Fax:
Mailing address:
  • Phone: 602-547-1836
  • Fax: 602-547-2806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number2019006569
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-30671
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number296422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: