Individual ProviderRyan RuppertPsychiatry & NeurologyAllopathic & Osteopathic PhysiciansPractice Address1200 N State Street, Clinic Tower, Suite A7d, Los Angeles, CA 90033-1029(302) 258-6852PECOS EnrollmentBased on the most recent information from CMS, provider Ryan Ruppert does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1023699766Provider TypeIndividualFull NameRuppert, RyanGenderMaleSole ProprietorYesEnumeration Date4/15/2021Last Updated6/27/2024Contact InformationPractice LocationPractice Address1200 N State Street, Clinic Tower, Suite A7d, Los Angeles, CA 90033-1029Phone(302) 258-6852FaxUnlisted FaxMailing LocationMailing Address1200 N State St, Los Angeles, CA 90089-1001PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode2084P0800XPrimaryDescriptionPsychiatry & NeurologyAllopathic & Osteopathic PhysiciansLicenseA186096CaliforniaCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer