Healthcare Provider Details

I. General information

NPI: 1265383699
Provider Name (Legal Business Name): PATRICK RYAN DO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2026
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 RESERVOIR DR STE 209
SAN DIEGO CA
92120-5186
US

IV. Provider business mailing address

5555 RESERVOIR DR STE 209
SAN DIEGO CA
92120-5186
US

V. Phone/Fax

Practice location:
  • Phone: 619-289-8111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICK RYAN
Title or Position: PHYSICIAN
Credential: DO
Phone: 619-289-8111