1467770263 NPI number — VICTORIA ONE HOSPICE, INC.

Table of content: JOANNA SPIRA RIESS MD (NPI 1770809022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467770263 NPI number — VICTORIA ONE HOSPICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VICTORIA ONE HOSPICE, 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:
1467770263
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
448 E FOOTHILL BLVD
Provider Second Line Business Mailing Address:
STE 204
Provider Business Mailing Address City Name:
SAN DIMAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91773-1205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-599-0055
Provider Business Mailing Address Fax Number:
909-599-0051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
448 E FOOTHILL BLVD
Provider Second Line Business Practice Location Address:
STE 204
Provider Business Practice Location Address City Name:
SAN DIMAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91773-1205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-599-0055
Provider Business Practice Location Address Fax Number:
909-599-0051
Provider Enumeration Date:
05/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SISON
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
909-599-0055

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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