MEDICARE: MR. RYAN MICHAEL MONAHAN LAC

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	171100000X	Acupuncturist	17497	CA

General Provider Information

NPI Number	:	1225566748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RYAN MICHAEL MONAHAN LAC

Provider Business Mailing Address
First Line	:	508 1/2 N SPAULDING AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-1846
Country	:	US
Telephone Number	:	415-283-5010
Fax Number	:

Provider Business Practice Location Address
First Line	:	508 1/2 N SPAULDING AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-1846
Country	:	US
Telephone Number	:	415-283-5010
Fax Number	:

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

Provider Enumeration Date	:	05/28/2017
Last Update Date	:	07/21/2022

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