Provider Demographics
NPI:1871969204
Name:CUFFEE-ANSARRA, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:CUFFEE-ANSARRA
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 1:3510 MOORPARK AVE
Mailing Address - Street 2:APARTMENT A302
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-2122
Mailing Address - Country:US
Mailing Address - Phone:860-202-1515
Mailing Address - Fax:
Practice Address - Street 1:39465 PASEO PADRE PKWY
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-5350
Practice Address - Country:US
Practice Address - Phone:510-745-9151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program