# RYAN C PETERSON MD INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609166545
- **Authorized official:** RYAN C PETERSON MD (DIRECT OWNER)
- **Authorized official phone:** (310) 266-3774

## Contact information

- **Practice address:** 3209 HILLOCK DR, LOS ANGELES, CA 90068-1427
- **Practice address phone:** (310) 266-3774
- **Practice address fax:** (323) 380-7420
- **Mailing address:** PO BOX 7001, TARZANA, CA 91357-7001
- **Mailing address phone:** (818) 888-7815
- **Mailing address fax:** (818) 715-1722

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | A103097 | CA | Yes |

## Other

- **Enumeration date:** 04/12/2011
- **Last updated:** 02/10/2020