MEDICARE: COLLEEN M. RYAN MD

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	207Q00000X	Family Medicine Physician	C133544	CA

General Provider Information

NPI Number	:	1952408007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN M. RYAN MD

Provider Business Mailing Address
First Line	:	9201 W SUNSET BLVD STE 701
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90069-3708
Country	:	US
Telephone Number	:	310-855-2558
Fax Number	:	303-441-2388

Provider Business Practice Location Address
First Line	:	9201 W SUNSET BLVD STE 701
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90069-3708
Country	:	US
Telephone Number	:	310-855-2558
Fax Number	:	888-747-2520

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	09/27/2022

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