Healthcare Provider Details

I. General information

NPI: 1578437547
Provider Name (Legal Business Name): RYAN YUTUC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12133 VISTA RANCH AVE
SYLMAR CA
91342-5510
US

IV. Provider business mailing address

12133 VISTA RANCH AVE
SYLMAR CA
91342-5510
US

V. Phone/Fax

Practice location:
  • Phone: 818-434-1064
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberVN216244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: