Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | G33037 | CA |
N | 207VG0400X | Gynecologist | G33037 | CA |
N | 207VX0000X | Obstetrician | G33037 | CA |
NPI | 1124149653 |
---|---|
Provider Name | Timothy B Riley |
First Address | San Diego, CA 92103-2132 |
Second Address | San Diego, CA 92103-2132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 09/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A45394 | (02) | CA |
ZZZ57305Z | BLUE SHIELD OF CA (01) | CA |