MEDICARE: DR. ANNA R RYAN PHD LMFT

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	106H00000X	Marriage & Family Therapist	24640	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	24640	OTHER	CA	LMFT

General Provider Information

NPI Number	:	1467857417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNA R RYAN PHD LMFT

Provider Business Mailing Address
First Line	:	2519 DENVER ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-3340
Country	:	US
Telephone Number	:	619-276-0747
Fax Number	:

Provider Business Practice Location Address
First Line	:	2519 DENVER ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-3340
Country	:	US
Telephone Number	:	619-276-0747
Fax Number	:

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

Provider Enumeration Date	:	11/01/2014
Last Update Date	:	11/01/2014

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