Provider Demographics
NPI:1497501670
Name:DYBERG, RYAN DIANNA
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:DIANNA
Last Name:DYBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73124 CATALINA WAY
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-2827
Mailing Address - Country:US
Mailing Address - Phone:310-780-9074
Mailing Address - Fax:
Practice Address - Street 1:73271 FRED WARING DR
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-2883
Practice Address - Country:US
Practice Address - Phone:760-469-9650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-27
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician