Ryan Colletta

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

64424 Issued in CA

Practice address

26357 McBean Pkwy Ste 255
Valencia, CA 91355-5504

Phone

(661) 255-1515

Fax

(661) 255-1661

NPI assigned

Apr 21, 2011

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ryan Colletta Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 26, 2016 through Apr 26, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Henry Mayo Newhall Memorial Hospital

  • General Acute Care Hospital
  • Valencia, CA
  • NPI 1780668434
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1303344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438992000000",
    "number": "1962793174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26357 MCBEAN PKWY STE 255",
            "city": "VALENCIA",
            "state": "CA",
            "postal_code": "913555504",
            "telephone_number": "661-255-1515",
            "fax_number": "661-255-1661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26357 MCBEAN PKWY STE 255",
            "city": "VALENCIA",
            "state": "CA",
            "postal_code": "913555504",
            "telephone_number": "661-255-1515",
            "fax_number": "661-255-1661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLETTA",
        "first_name": "RYAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-21",
        "last_updated": "2015-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "64424",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RYAN",
            "last_name": "COLLETTA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Reagan Cohen
• Pamela Suzette Colby, M.D.
• Steve M Colby, CRNA
• Liam Cole, PTA
• Catherine Colella-Radakovich
• Kiana Jasmine Marie Collins
• Lukas John Colman, BCBA
• Comfort Care Adhc, Inc
• Comfort Shoes
• Compass Center, Inc

• Oral and Maxillofacial Surgery (Dentist) in Valencia, CA
• Providers in Valencia, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.