Healthcare Provider Details

I. General information

NPI: 1265832950
Provider Name (Legal Business Name): RYAN NOLAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2014
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 NEILSON ST STE 125
WATSONVILLE CA
95076-2491
US

IV. Provider business mailing address

65 NEILSON ST STE 102
WATSONVILLE CA
95076-2491
US

V. Phone/Fax

Practice location:
  • Phone: 831-768-6266
  • Fax: 831-768-6219
Mailing address:
  • Phone: 831-768-6266
  • Fax: 831-768-6219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA161287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: