Healthcare Provider Details

I. General information

NPI: 1497251722
Provider Name (Legal Business Name): RYAN ERICH DEAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 CONVOY ST STE 201
SAN DIEGO CA
92111-3770
US

IV. Provider business mailing address

3750 CONVOY ST STE 201
SAN DIEGO CA
92111-3770
US

V. Phone/Fax

Practice location:
  • Phone: 858-278-8031
  • Fax:
Mailing address:
  • Phone: 858-278-8031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number33848
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number185521
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: