Healthcare Provider Details

I. General information

NPI: 1285952853
Provider Name (Legal Business Name): JEFFREY B RIKER MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 10/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 LONG BEACH BLVD 210
LONG BEACH CA
90806-1516
US

IV. Provider business mailing address

2840 LONG BEACH BLVD 210
LONG BEACH CA
90806-1516
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-5864
  • Fax:
Mailing address:
  • Phone: 562-933-5864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY B RIKER
Title or Position: OWNER
Credential: MD
Phone: 562-933-5864