Healthcare Provider Details

I. General information

NPI: 1871080606
Provider Name (Legal Business Name): PATRICK JAMES RYAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6699 ALVARADO RD STE 2100
SAN DIEGO CA
92120-5238
US

IV. Provider business mailing address

6699 ALVARADO RD STE 2100
SAN DIEGO CA
92120-5238
US

V. Phone/Fax

Practice location:
  • Phone: 619-229-3909
  • Fax:
Mailing address:
  • Phone: 619-229-3909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21509
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberW20A21509
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: