Healthcare Provider Details

I. General information

NPI: 1629710322
Provider Name (Legal Business Name): RYAN KATWAROO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1397 MEDICAL PARK BLVD STE 220
WELLINGTON FL
33414-3187
US

IV. Provider business mailing address

1397 MEDICAL PARK BLVD STE 220
WELLINGTON FL
33414-3187
US

V. Phone/Fax

Practice location:
  • Phone: 561-652-8657
  • Fax:
Mailing address:
  • Phone: 561-652-8657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: