Healthcare Provider Details

I. General information

NPI: 1407119670
Provider Name (Legal Business Name): RYLIST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 E WILBUR RD
THOUSAND OAKS CA
91360-7935
US

IV. Provider business mailing address

155 E WILBUR RD
THOUSAND OAKS CA
91360-7935
US

V. Phone/Fax

Practice location:
  • Phone: 833-239-3552
  • Fax:
Mailing address:
  • Phone: 833-239-3552
  • Fax: 805-777-9226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberLIC-7-11-3494
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberLIC-7-11-3494
License Number StateCA

VIII. Authorized Official

Name: STEVE ZAMARRIPA
Title or Position: OWNER/PRESIDENT
Credential: CEO
Phone: 818-584-5615