Healthcare Provider Details

I. General information

NPI: 1467264002
Provider Name (Legal Business Name): RYDR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2025
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14856 W COLUMBINE DR
SURPRISE AZ
85379-5933
US

IV. Provider business mailing address

14856 W COLUMBINE DR
SURPRISE AZ
85379-5933
US

V. Phone/Fax

Practice location:
  • Phone: 602-579-2028
  • Fax:
Mailing address:
  • Phone: 602-579-2028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State

VIII. Authorized Official

Name: KATRINA SUZANNE NOEL SIMENTAL
Title or Position: OWNER
Credential:
Phone: 602-579-2028