| Doctor Name: | MR. RYAN ALI EHTESSABIAN |
| NPI Number: | 1023365467 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.S., CNS |
| License Number: | CNS #16139 |
| Business Practice Address: | 2725 Via Victoria Palos Verdes Estates, CA - 902744475 |
| Business Phone Number: | 3102930036 |
| Business Fax Number: | |
| Mailing Address: | 31234 Palos Verdes Dr W, #2 RANCHO PALOS VERDES |
| State: | CA |
| Postal Code: | 902755361 |
| Phone Number: | 3102930036 |
| Fax Number: | |
| NPI Enumeration Date: | 08/03/2012 |
| NPI Last Update Date: | 08/03/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133NN1002X |
| License Number: | CNS #16139 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Nutritionist |
| Taxonomy Specialization: | Nutrition, Education |
| Taxonomy Definition: | |