Provider Demographics
NPI:1679803423
Name:RYAN, ERICA NICOLE
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:NICOLE
Last Name:RYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45849 AMBARA CT
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-3425
Mailing Address - Country:US
Mailing Address - Phone:951-265-2130
Mailing Address - Fax:
Practice Address - Street 1:45849 AMBARA CT
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-3425
Practice Address - Country:US
Practice Address - Phone:951-265-2130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-29
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool