Healthcare Provider Details

I. General information

NPI: 1093198178
Provider Name (Legal Business Name): RYAN PERUMPAIL MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

458 N DOHENY DR UNIT 46892
WEST HOLLYWOOD CA
90048-1737
US

V. Phone/Fax

Practice location:
  • Phone: 732-682-1078
  • Fax: 888-374-8935
Mailing address:
  • Phone: 732-682-1078
  • Fax: 888-374-8935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA128296
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA128296
License Number StateCA

VIII. Authorized Official

Name: RYAN PERUMPAIL
Title or Position: OWNER / PRESIDENT
Credential: MD
Phone: 732-682-1078