Healthcare Provider Details

I. General information

NPI: 1659213429
Provider Name (Legal Business Name): RYAN A CARR NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 BROCKTON AVE
RIVERSIDE CA
92506-1862
US

IV. Provider business mailing address

40225 DANBURY CT
TEMECULA CA
92591-7557
US

V. Phone/Fax

Practice location:
  • Phone: 844-881-4326
  • Fax:
Mailing address:
  • Phone: 951-265-6651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95039218
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: