RYAN BOUDREAU (NPI# 1093194284) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093194284 |
| Entity Type | Individual |
| Full Name | RYAN BOUDREAU |
| Credential | PA-C |
| Practice Address |
6955 Golfcrest Dr Apt 1030 San Diego CA 92119-2470 |
| Practice Telephone | 2407500728 |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2019-10-17 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 1164982 | Physician Assistants & Advanced Practice Nursing Providers | |
| N | 1710I1002X |
Military Health Care Provider Specialization: Independent Duty Corpsman |
Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770902074 | Ryan Boudreau | Student in an Organized Health Care Education/Training Program | Uc Medical Center Department of Surgery, 231 Albert Sabin Way Ml0558, Cincinnati, OH 45267-0558 | 2014-04-15 |
| 1033741236 | Ryan Boudreau | Physician Assistant | 44 Binney St, Boston, MA 02115-6084 | 2020-02-06 |
| 1346595998 | Ryan James Boudreau | Pharmacist | 4500 Veterans Memorial Blvd, T-1449, Metairie, LA 70006-5330 | 2012-07-19 |
| Street Address |
6955 GOLFCREST DR APT 1030 |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92119-2470 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417462565 | Celena Katherine Wheeler | Behavior Technician | 6965 Golfcrest Dr, San Diego, CA 92119 | 2017-12-12 |
| 1932437969 | Halyna Yevgenivna West | Internal Medicine | 6280 Jackson Drive, Suite #8, San Diego, CA 92119 | 2009-12-02 |
| 1346406303 | Marcel T. Bougher, Dds, Inc | Clinic/Center | 6280 Jackson Drive Suite 1, San Diego, CA 92119 | 2008-07-30 |
| 1316163819 | Mark W Christensen | Dentist | 7187 Navajo Rd., Suite A, San Diego, CA 92119 | 2007-04-17 |
| 1154429306 | Zoe Cristina Suciu | Dentist | 7424 Jackson Dr, #6, San Diego, CA 92119 | 2006-09-20 |
| 1255442448 | Ashley Allen Goodman | Dentist | 8736 Lake Murry Blvd, Ste 108, San Diego, CA 92119 | 2006-08-31 |
| 1811006067 | Ashley A Goodman Dds A Professional Corporation | Dentist | 8736 Lake Murray Blvd, Ste 108, San Diego, CA 92119 | 2006-08-30 |
| 1205943495 | Michael Anthony Stefanidis | Dentist | 7424 Jackson Dr #8, San Diego, CA 92119 | 2006-08-24 |
| 1720003056 | Miranda B Williams | Psychologist | 7290 Navajo Rd Ste 105, San Diego, CA 92119 | 2006-07-13 |
| 1003301391 | Allen Chung | Optometrist | 8312 Lake Murray Blvd Ste C, San Diego, CA 92119 | 2018-06-28 |
| Find all providers in zip 92119 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083213706 | Courtney Kathryn Hopp | Physician Assistant | 4060 Fourth Ave Ste 209, San Diego, CA 92103-2120 | 2020-10-23 |
| 1639776503 | Nathan Tuan Dinh | Physician Assistant | 8296 Via Escalada, San Diego, CA 92129-2223 | 2020-10-05 |
| 1750988671 | Denise Aquino | Physician Assistant | 7322 Mesa College Dr Apt 7, San Diego, CA 92111-4943 | 2020-10-04 |
| 1962009183 | Courtney Krysl | Physician Assistant | 14434 Corte Lampara, San Diego, CA 92129-3818 | 2020-10-01 |
| 1497369284 | Brian Carroll | Physician Assistant | 7242 Melotte St, San Diego, CA 92119-1613 | 2020-08-31 |
| 1871104067 | Satoshi Ikeda | Physician Assistant | 16198 Paseo Del Sur, San Diego, CA 92127-6155 | 2020-08-12 |
| 1760009989 | Lili Tran | Physician Assistant | 8865 Calle Tragar, San Diego, CA 92129-2156 | 2020-07-03 |
| 1245857259 | Kendra Roberta Witt | Physician Assistant | 11396 Poblado Rd, San Diego, CA 92127-1351 | 2020-06-25 |
| 1336766344 | Brandon Scott Johnson | Physician Assistant | 1540 Oliver Ave Apt C, San Diego, CA 92109-5595 | 2020-06-25 |
| 1104441021 | Kira Ann Tellache | Physician Assistant | 4520 Executive Dr Ste 325, San Diego, CA 92121-3087 | 2020-06-16 |
| Find all providers in SAN DIEGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.