Healthcare Provider Details

I. General information

NPI: 1144280231
Provider Name (Legal Business Name): DAWNMARIE RISLEY-CHILDS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAWN MARIE RISLEY D.O.

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40800 COMPTCHE UKIAH RD
MENDOCINO CA
95460-9012
US

IV. Provider business mailing address

40800 COMPTCHE UKIAH RD
MENDOCINO CA
95460-9012
US

V. Phone/Fax

Practice location:
  • Phone: 845-901-0521
  • Fax:
Mailing address:
  • Phone: 845-901-0521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A7736
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: