Healthcare Provider Details

I. General information

NPI: 1558654921
Provider Name (Legal Business Name): GAVIN PATRICK RIPP D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 COYLE AVE STE 202
CARMICHAEL CA
95608-6333
US

IV. Provider business mailing address

6620 COYLE AVE STE 202
CARMICHAEL CA
95608-6333
US

V. Phone/Fax

Practice location:
  • Phone: 916-961-3434
  • Fax:
Mailing address:
  • Phone: 916-961-3434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5115
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: