MEDICARE: PEYTON LEIGH VAN RIPER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1710762539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEYTON LEIGH VAN RIPER

Provider Business Mailing Address
First Line	:	1134 ALTA LOMA RD APT 214
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90069-2427
Country	:	US
Telephone Number	:	916-687-1195
Fax Number	:

Provider Business Practice Location Address
First Line	:	10540 SHERMAN GROVE AVE
Second Line	:
City	:	SUNLAND
State	:	CA
Zip	:	91040-1913
Country	:	US
Telephone Number	:	916-687-1195
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2023
Last Update Date	:	12/11/2023

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Directions to “ PEYTON LEIGH VAN RIPER ” Practice Location

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