Basic Information
| Provider Information | |||||||||
| NPI: | 1285169367 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUEVANOS | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6134 AVENIDA CHAMNEZ | ||||||||
| Address2: | |||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920377441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8583541726 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1147 NW 64TH TER | ||||||||
| Address2: | TERRACE | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326054218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523335168 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2017 | ||||||||
| LastUpdateDate: | 12/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | A166859 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.