Healthcare Provider Details

I. General information

NPI: 1215658331
Provider Name (Legal Business Name): PROVIDENCE JANELLE RIGGS MSW, PPSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3038 DELTA AVE
LONG BEACH CA
90810-2843
US

IV. Provider business mailing address

208 E MEDA AVE
GLENDORA CA
91741-2622
US

V. Phone/Fax

Practice location:
  • Phone: 562-426-5571
  • Fax:
Mailing address:
  • Phone: 626-384-0335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number124767
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: