Healthcare Provider Details

I. General information

NPI: 1669548707
Provider Name (Legal Business Name): STEVEN L RYDER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 W WARNER AVE
SANTA ANA CA
92704-5331
US

IV. Provider business mailing address

PO BOX 208
YORBA LINDA CA
92885-0208
US

V. Phone/Fax

Practice location:
  • Phone: 714-546-4233
  • Fax: 714-546-6101
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA13850
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: