MEDICARE: RYAN BACANI

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	163W00000X	Registered Nurse	808705	CA

General Provider Information

NPI Number	:	1477038354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN BACANI

Provider Business Mailing Address
First Line	:	4506 N BANNER DR APT 3
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-1859
Country	:	US
Telephone Number	:	951-941-7690
Fax Number	:

Provider Business Practice Location Address
First Line	:	4506 N BANNER DRIVE APT 3
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807
Country	:	US
Telephone Number	:	951-941-7690
Fax Number	:

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

Provider Enumeration Date	:	09/26/2018
Last Update Date	:	09/26/2018

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Directions to “ RYAN BACANI ” Practice Location

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