=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649394636
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GERRI LYNN RYAN LM, CPM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2007
-----------------------------------------------------
Last Update Date | 09/26/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15644 POMERADO RD STE 302
-----------------------------------------------------
City | POWAY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92064-2455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-278-2930
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 275 S WORTHINGTON ST SPC 120
-----------------------------------------------------
City | SPRING VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91977-6344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-434-9188
-----------------------------------------------------
Fax | 858-278-2943
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number | LM 162
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------