Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY12140 | CA |
NPI | 1134283948 |
---|---|
Provider Name | Dr. Joseph M Riddle |
First Address | Folsom, CA 95630-8707 |
Second Address | Folsom, CA 95630-8707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 03/01/2022 |