MEDICARE: MRS. ANGELA MARIE RYALS MA,PPS-SC

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	101YS0200X	School Counselor

General Provider Information

NPI Number	:	1184424590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA MARIE RYALS MA,PPS-SC

Provider Business Mailing Address
First Line	:	1500 LIZZIE ST
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-3062
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 LIZZIE ST
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-3062
Country	:	US
Telephone Number	:	805-549-1218
Fax Number	:

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

Provider Enumeration Date	:	03/14/2025
Last Update Date	:	03/14/2025

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