Healthcare Provider Details

I. General information

NPI: 1629204110
Provider Name (Legal Business Name): MRS. LORI RIEGERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12440 FIRESTONE BLVD
NORWALK CA
90650-4328
US

IV. Provider business mailing address

821 N GRANDVIEW AVE
COVINA CA
91723-1318
US

V. Phone/Fax

Practice location:
  • Phone: 562-864-7821
  • Fax:
Mailing address:
  • Phone: 626-331-5301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number34662
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: