Healthcare Provider Details

I. General information

NPI: 1033529615
Provider Name (Legal Business Name): MICHELLE LIU RIEDERER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 WELCH RD
PALO ALTO CA
94304-1601
US

IV. Provider business mailing address

401 QUARRY RD ROOM 2206
STANFORD CA
94305
US

V. Phone/Fax

Practice location:
  • Phone: 650-723-5511
  • Fax:
Mailing address:
  • Phone: 650-725-0957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA148711
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: