Healthcare Provider Details

I. General information

NPI: 1780782615
Provider Name (Legal Business Name): YVONNE ANNE RIBA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 BEVINS CT
LAKEPORT CA
95453-9754
US

IV. Provider business mailing address

925 BEVINS CT
LAKEPORT CA
95453-9754
US

V. Phone/Fax

Practice location:
  • Phone: 707-263-8382
  • Fax: 707-263-5019
Mailing address:
  • Phone: 707-263-8382
  • Fax: 707-263-1909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3009
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number52811
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: