Organization
ELLIOT RYAN CARLISLE MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELLIOT RYAN CARLISLE MD (OWNER AND SURGEON)
(818) 986-0200
Entity
Organization
Contact information
Practice address
17525 VENTURA BLVD STE 203, ENCINO, CA 91316-5109
(310) 986-0200
(818) 986-4390
Mailing address
17525 VENTURA BLVD STE 203, ENCINO, CA 91316-5109
(310) 986-0200
(818) 986-4390
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
A74780
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1669453676
TYPE 1 NPI
CA
01
—
A74780
STATE LICENSE
CA
Enumeration date
05/08/2008
Last updated
05/08/2008
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