Healthcare Provider Details

I. General information

NPI: 1184049140
Provider Name (Legal Business Name): RYAN LEWIS ANDERSON M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2014
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 PLUMAS BLVD STE 201
YUBA CITY CA
95991-5077
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 530-749-3463
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberA151182
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: