Healthcare Provider Details

I. General information

NPI: 1457129843
Provider Name (Legal Business Name): LAUREN RIELE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 TELEGRAPH AVE
BERKELEY CA
94705-2017
US

IV. Provider business mailing address

3357 MORAGA BLVD
LAFAYETTE CA
94549-4641
US

V. Phone/Fax

Practice location:
  • Phone: 510-841-4525
  • Fax:
Mailing address:
  • Phone: 513-807-1225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA66910
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: