Healthcare Provider Details

I. General information

NPI: 1821583170
Provider Name (Legal Business Name): RYAN A. FUNK BA, CADC-III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 E LOS ANGELES AVE
SIMI VALLEY CA
93065-2871
US

IV. Provider business mailing address

1227 E LOS ANGELES AVE
SIMI VALLEY CA
93065-2871
US

V. Phone/Fax

Practice location:
  • Phone: 310-721-1666
  • Fax:
Mailing address:
  • Phone: 310-721-1666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberB001320420
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: