Provider Demographics
NPI:1053939611
Name:TOGNOTTI, RYAN (PAC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:TOGNOTTI
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:973 MICA DR STE 201
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89705-7258
Mailing Address - Country:US
Mailing Address - Phone:775-783-6109
Mailing Address - Fax:775-783-6178
Practice Address - Street 1:973 MICA DR. SUITE 201
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89705
Practice Address - Country:US
Practice Address - Phone:775-783-6109
Practice Address - Fax:775-783-6178
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA2517363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant