Healthcare Provider Details

I. General information

NPI: 1831614643
Provider Name (Legal Business Name): ANTHONY BARNETT RIGGINS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S. TUSTIN STREET BLDG. D
ORANGE CA
92866
US

IV. Provider business mailing address

401 S TUSTIN ST BLDG D
ORANGE CA
92866-2550
US

V. Phone/Fax

Practice location:
  • Phone: 714-289-3936
  • Fax: 714-289-3938
Mailing address:
  • Phone: 714-289-3936
  • Fax: 714-289-3938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: