Healthcare Provider Details

I. General information

NPI: 1821922709
Provider Name (Legal Business Name): RYANN THOMISON RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 PAU HANA DR
SOQUEL CA
95073-9686
US

IV. Provider business mailing address

950 PAU HANA DR
SOQUEL CA
95073-9686
US

V. Phone/Fax

Practice location:
  • Phone: 916-205-5658
  • Fax:
Mailing address:
  • Phone: 916-205-5658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: