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General NPI Number Information
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NPI Number | 1720402597
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Entity Type | Individual
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Provider Name | RYAN RADENBAUGH
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Gender | Male
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Dates
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Enumeration Date | 02/13/2014
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Last Update Date | 05/27/2014
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Provider Practice Location Address
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Address Line | 3310 VERDUGO RD
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City | LOS ANGELES
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State | CA
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Zip | 90065-2845
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Country | US
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Telephone | 818-822-7152
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Fax |
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Provider Business Mailing Address
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Address Line | 1814 JACKSON ST
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City | BURBANK
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State | CA
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Zip | 91504
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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 | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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