MEDICARE: DR. RYAN MICHAEL GLYNN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	A200673	CA

General Provider Information

NPI Number	:	1093202129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN MICHAEL GLYNN MD

Provider Business Mailing Address
First Line	:	6190 CORNERSTONE CT E STE 212
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-4701
Country	:	US
Telephone Number	:	858-246-6305
Fax Number	:	833-660-7845

Provider Business Practice Location Address
First Line	:	6190 CORNERSTONE CT E STE 212
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-4701
Country	:	US
Telephone Number	:	858-246-6305
Fax Number	:	833-660-7845

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2018
Last Update Date	:	02/12/2026

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