Healthcare Provider Details

I. General information

NPI: 1245154020
Provider Name (Legal Business Name): JUSTIN RYAN PPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N RAMONA BLVD
SAN JACINTO CA
92582-2552
US

IV. Provider business mailing address

2045 S SAN JACINTO AVE
SAN JACINTO CA
92583-5626
US

V. Phone/Fax

Practice location:
  • Phone: 951-487-7710
  • Fax:
Mailing address:
  • Phone: 951-487-7710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number260143452
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: