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General NPI Number Information
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NPI Number | 1093361925
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Entity Type | Individual
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Provider Name | SCOTT LAWRENCE RYAN BVMS
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Gender | Male
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Dates
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Enumeration Date | 08/15/2019
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Last Update Date | 08/15/2019
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Provider Practice Location Address
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Address Line | 1833 S EL CAMINO REAL
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-3245
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Country | US
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Telephone | 949-492-5777
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Fax |
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Provider Business Mailing Address
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Address Line | 9 ELLIOT LN
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City | TRABUCO CANYON
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State | CA
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Zip | 92679-5155
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Country | US
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Telephone |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 240872
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License Number State | KY
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