Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175L00000X | Homeopath |
NPI | 1518176270 |
---|---|
Provider Name | David Riley |
First Address | La Mesa, CA 91944-3714 |
Second Address | La Mesa, CA 91941-5316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
17 | OTHER SERVICE PROVIDER (01) | CA |