Healthcare Provider Details

I. General information

NPI: 1184697658
Provider Name (Legal Business Name): RYAN D WELLS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 N BRENT ST STE 403B
VENTURA CA
93003-2824
US

IV. Provider business mailing address

5855 OLIVAS PARK DR
VENTURA CA
93003-7672
US

V. Phone/Fax

Practice location:
  • Phone: 805-948-6920
  • Fax: 805-948-1501
Mailing address:
  • Phone: 805-948-2801
  • Fax: 805-667-2865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA73951
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberA73951
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberA73951
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA73951
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: