Healthcare Provider Details

I. General information

NPI: 1164379749
Provider Name (Legal Business Name): RIYAN MARKOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

673 LISBON ST
DALY CITY CA
94014-2772
US

IV. Provider business mailing address

673 LISBON ST
DALY CITY CA
94014-2772
US

V. Phone/Fax

Practice location:
  • Phone: 650-374-2005
  • Fax:
Mailing address:
  • Phone: 650-374-2005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number741080
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: