Healthcare Provider Details

I. General information

NPI: 1316850365
Provider Name (Legal Business Name): MR. ROBERT LOUIS RICCIARDELLI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 TENNANT AVE STE G
MORGAN HILL CA
95037-5529
US

IV. Provider business mailing address

2470 BANTRY LN
SOUTH SAN FRANCISCO CA
94080-5107
US

V. Phone/Fax

Practice location:
  • Phone: 646-388-2937
  • Fax:
Mailing address:
  • Phone: 646-388-2937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: