Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | A53233 | CA |
NPI | 1033310347 |
---|---|
Provider Name | Dr. Daniel Ries |
First Address | Long Beach, CA 90813-3026 |
Second Address | Long Beach, CA 90813-3026 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 08/07/2007 |