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Individual

MR. RYAN BLACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
802 MAGNOLIA AVE STE 205, CORONA, CA 92879-3144
(951) 281-2730
Mailing address
40335 WINCHESTER RD, SUITE E #238, TEMECULA, CA 92591
(760) 420-4123

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA63384
CA

Other

Enumeration date
10/23/2023
Last updated
10/30/2024
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