Healthcare Provider Details

I. General information

NPI: 1043829229
Provider Name (Legal Business Name): JESSI ELIZABETH RIEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 W 5TH ST
HANFORD CA
93230-5029
US

IV. Provider business mailing address

2357 ACACIA AVE
CLOVIS CA
93612-4046
US

V. Phone/Fax

Practice location:
  • Phone: 877-960-3426
  • Fax:
Mailing address:
  • Phone: 208-697-2512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number58212
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: