Provider Demographics
NPI:1053299230
Name:PEPIN, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:PEPIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 VALLEY HOUSE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-4931
Mailing Address - Country:US
Mailing Address - Phone:707-794-6016
Mailing Address - Fax:
Practice Address - Street 1:1300 VALLEY HOUSE DR
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-4927
Practice Address - Country:US
Practice Address - Phone:707-794-6016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA210189066103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool