Healthcare Provider Details

I. General information

NPI: 1699849463
Provider Name (Legal Business Name): VON RYAN DURAL TAAL PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 VAN SLYKE CT
RIPON CA
95366-9216
US

IV. Provider business mailing address

433 VAN SLYKE CT
RIPON CA
95366-9216
US

V. Phone/Fax

Practice location:
  • Phone: 209-648-3476
  • Fax:
Mailing address:
  • Phone: 209-648-3476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberRPH54737
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: