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General NPI Number Information
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NPI Number | 1013348580
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Entity Type | Individual
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Provider Name | GWENDOLYN JEAN RYAN M.S.
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Gender | Female
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Dates
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Enumeration Date | 12/09/2013
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Last Update Date | 12/09/2013
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Provider Practice Location Address
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Address Line | 207 SANTA ANITA STREET
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City | SAN GABRIEL
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State | CA
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Zip | 91776-1160
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Country | US
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Telephone | 626-282-9250
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Fax | 626-282-9953
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Provider Business Mailing Address
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Address Line | 207 SANTA ANITA STREET SUITE 338
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City | SAN GABRIEL
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State | CA
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Zip | 91776-1160
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Country | US
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Telephone | 626-282-9250
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Fax | 626-282-9953
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 170300000X
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Taxonomy Name | Genetic Counselor (M.S.)
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License Number | GC000324
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License Number State | CA
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