Provider Demographics
NPI:1538853916
Name:RYAN, JAMELLE (HHP)
Entity type:Individual
Prefix:
First Name:JAMELLE
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:HHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 N ACACIA AVE
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1103
Mailing Address - Country:US
Mailing Address - Phone:858-259-6000
Mailing Address - Fax:
Practice Address - Street 1:107 N ACACIA AVE
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1103
Practice Address - Country:US
Practice Address - Phone:858-259-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach