Healthcare Provider Details

I. General information

NPI: 1457477473
Provider Name (Legal Business Name): DANA MSK RILEY PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 N 1ST ST
FRESNO CA
93726-2304
US

IV. Provider business mailing address

4440 N 1ST ST
FRESNO CA
93726-2304
US

V. Phone/Fax

Practice location:
  • Phone: 559-225-1102
  • Fax: 559-225-1030
Mailing address:
  • Phone: 559-225-1102
  • Fax: 559-225-1030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY20798
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: