MEDICARE: MS. GERRI LYNN RYAN LM, CPM

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	176B00000X	Midwife	LM 162	CA

General Provider Information

NPI Number	:	1649394636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GERRI LYNN RYAN LM, CPM

Provider Business Mailing Address
First Line	:	275 S WORTHINGTON ST SPC 120
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91977-6344
Country	:	US
Telephone Number	:	619-434-9188
Fax Number	:	858-278-2943

Provider Business Practice Location Address
First Line	:	15644 POMERADO RD STE 302
Second Line	:
City	:	POWAY
State	:	CA
Zip	:	92064-2455
Country	:	US
Telephone Number	:	858-278-2930
Fax Number	:

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

Provider Enumeration Date	:	03/17/2007
Last Update Date	:	09/26/2019

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