1518736271 NPI number — MISS RIANNE MARGARETTE MEDINA RN BSN

Table of content: MISS RIANNE MARGARETTE MEDINA RN BSN (NPI 1518736271)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518736271 NPI number — MISS RIANNE MARGARETTE MEDINA RN BSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEDINA
Provider First Name:
RIANNE
Provider Middle Name:
MARGARETTE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
RN BSN
Provider Gender Code:
F

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:
1518736271
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9903 SANTA MONICA BLVD STE 924
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEVERLY HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90212-1606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-904-8335
Provider Business Mailing Address Fax Number:
866-279-2860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 HILLIARD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTEREY PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91754-1119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-904-8335
Provider Business Practice Location Address Fax Number:
866-279-2860
Provider Enumeration Date:
12/21/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  689039 , 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)





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