Individual
RYAN THEBO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8880 RIO SAN DIEGO DR STE 800, SAN DIEGO, CA 92108-1642
(619) 363-6570
Mailing address
440 N BARRANCA AVE APT 20, COVINA, CA 91723-1722
(888) 909-8676
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
95003068
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95003068
CA
Other
Enumeration date
10/24/2016
Last updated
06/12/2023
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