Healthcare Provider Details

I. General information

NPI: 1588412431
Provider Name (Legal Business Name): RYRA INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10950 CHURCH ST 2522
RANCHO CUCAMONGA CA
91730-8084
US

IV. Provider business mailing address

10950 CHURCH ST 2522
RANCHO CUCAMONGA CA
91730-8084
US

V. Phone/Fax

Practice location:
  • Phone: 323-678-3874
  • Fax:
Mailing address:
  • Phone: 323-678-3874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: JAZS LOVELACE
Title or Position: CEO
Credential:
Phone: 323-678-3874