Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 1224667 | TX |
NPI | 1053665257 |
---|---|
Provider Name | Dr. Mark Riebel |
First Address | Camp Pendleton, CA 92055-5191 |
Second Address | Camp Pendleton, CA 92055-5191 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2012 |
Last Update Date | 09/11/2012 |