1265655195 NPI number — J. FREDERICK RIEDEL, M.D., INC.

Table of content: (NPI 1265655195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265655195 NPI number — J. FREDERICK RIEDEL, M.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J. FREDERICK RIEDEL, M.D., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265655195
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 LA CASA VIA STE 260
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94598-3068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-934-6300
Provider Business Mailing Address Fax Number:
925-933-9547

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 LA CASA VIA STE 260
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALNUT CREEK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94598-3068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-934-6300
Provider Business Practice Location Address Fax Number:
925-933-9547
Provider Enumeration Date:
04/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RIEDEL
Authorized Official First Name:
J.
Authorized Official Middle Name:
FREDERICK
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
925-934-6300

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  A23985 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com