Healthcare Provider Details

I. General information

NPI: 1649194333
Provider Name (Legal Business Name): KYLE JOSEPH RILEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25411 SEA BLUFFS DR
DANA POINT CA
92629-2190
US

IV. Provider business mailing address

2339 N GLENNWOOD ST
ORANGE CA
92865-3509
US

V. Phone/Fax

Practice location:
  • Phone: 844-502-7996
  • Fax:
Mailing address:
  • Phone: 714-335-2113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT28077
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: