Healthcare Provider Details

I. General information

NPI: 1639053853
Provider Name (Legal Business Name): RISE PSYCHIATRY PHYSICIAN ASSISTANT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21031 VENTURA BLVD
WOODLAND HILLS CA
91364-2203
US

IV. Provider business mailing address

1755 N BROWN RD STE 200
LAWRENCEVILLE GA
30043-2018
US

V. Phone/Fax

Practice location:
  • Phone: 213-260-2330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: RYAN VOLK
Title or Position: OWNER
Credential:
Phone: 213-260-2330