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General NPI Number Information
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NPI Number | 1518778976
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Entity Type | Individual
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Provider Name | ELIJAH RYAN PHOENIX PMHNP
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Gender | Male
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Dates
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Enumeration Date | 01/15/2025
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Last Update Date | 08/06/2026
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Provider Practice Location Address
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Address Line | 215 S HICKORY ST STE 114
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City | ESCONDIDO
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State | CA
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Zip | 92025-4360
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Country | US
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Telephone | 866-905-9410
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Fax |
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Provider Business Mailing Address
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Address Line | 9951 HOLDER ST APT 49
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City | CYPRESS
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State | CA
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Zip | 90630-4009
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Country | US
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Telephone | 618-919-0972
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95232470
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95032063
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License Number State | CA
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