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General NPI Number Information
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NPI Number | 1023365467
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Entity Type | Individual
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Provider Name | RYAN ALI EHTESSABIAN M.S., CNS
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Gender | Male
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Dates
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Enumeration Date | 08/03/2012
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Last Update Date | 08/03/2012
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Provider Practice Location Address
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Address Line | 2725 VIA VICTORIA
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City | PALOS VERDES ESTATES
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State | CA
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Zip | 90274-4475
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Country | US
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Telephone | 310-293-0036
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Fax |
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Provider Business Mailing Address
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Address Line | 31234 PALOS VERDES DR W #2
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City | RANCHO PALOS VERDES
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State | CA
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Zip | 90275-5361
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Country | US
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Telephone | 310-293-0036
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Fax |
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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 | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number | CNS #16139
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License Number State | CA
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