Healthcare Provider Details

I. General information

NPI: 1043143886
Provider Name (Legal Business Name): RYAN NGUYEN RENNELS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 SANTIAGO ST
SAN FRANCISCO CA
94116-1526
US

IV. Provider business mailing address

1320 WILLOW PASS RD STE 700
CONCORD CA
94520-7926
US

V. Phone/Fax

Practice location:
  • Phone: 415-759-2222
  • Fax:
Mailing address:
  • Phone: 925-945-1474
  • Fax: 925-945-1768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number39787
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: