Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 028814 | CA |
N | 213EG0000X | General Practice | 028814 | CA |
N | 1223G0001X | General Practice | 032896 | CA |
N | 213EG0000X | General Practice | 032896 | CA |
N | 1223G0001X | General Practice | 053606 | CA |
N | 213EG0000X | General Practice | 053606 | CA |
N | 1223X0400X | Orthodontists | 016290 | CA |
NPI | 1013988971 |
---|---|
Provider Name | Dr. Paul W Riley |
First Address | San Fernando, CA 91340 |
Second Address | San Fernando, CA 91340 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 08/07/2007 |