Healthcare Provider Details

I. General information

NPI: 1932061413
Provider Name (Legal Business Name): RYAN MEZA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W BROADWAY SUITE 800
SAN DIEGO CA
92101-3546
US

IV. Provider business mailing address

3236 KNOLL WAY SUITE 800
RIVERSIDE CA
92501-1958
US

V. Phone/Fax

Practice location:
  • Phone: 951-990-7232
  • Fax:
Mailing address:
  • Phone: 951-990-7232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: