Healthcare Provider Details

I. General information

NPI: 1639863509
Provider Name (Legal Business Name): CHRISTOPHER RYDMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1693 MISSION DR STE 207
SOLVANG CA
93463-2635
US

IV. Provider business mailing address

3634 PALOMA ST
SANTA YNEZ CA
93460-9779
US

V. Phone/Fax

Practice location:
  • Phone: 213-926-2110
  • Fax:
Mailing address:
  • Phone: 213-926-2110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number138951
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: