Healthcare Provider Details

I. General information

NPI: 1902997802
Provider Name (Legal Business Name): RYAN MATTHEW LEVERENZ TECHNICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8930 OCEAN DR
CORPUS CHRISTI TX
78419-5201
US

IV. Provider business mailing address

3802 CARAVELLE PKWY APT 2804
CORPUS CHRISTI TX
78415-3517
US

V. Phone/Fax

Practice location:
  • Phone: 361-939-6270
  • Fax: 361-939-6207
Mailing address:
  • Phone: 361-939-6270
  • Fax: 361-939-6207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: