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General NPI Number Information
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NPI Number | 1447806021
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Entity Type | Individual
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Provider Name | JENNIFER DESTREZA RYAN MSN, AGNP
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Gender | Female
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Dates
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Enumeration Date | 08/10/2019
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Last Update Date | 08/10/2019
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Provider Practice Location Address
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Address Line | 5315 TORRANCE BLVD
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City | TORRANCE
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State | CA
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Zip | 90503-4011
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Country | US
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Telephone | 800-535-8446
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Fax |
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Provider Business Mailing Address
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Address Line | 3821 W 184TH PL
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City | TORRANCE
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State | CA
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Zip | 90504-4813
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Country | US
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Telephone | 310-634-9739
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 95012280
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License Number State | CA
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