Healthcare Provider Details

I. General information

NPI: 1861318941
Provider Name (Legal Business Name): MATT RIGGS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4656 NARRAGANSETT AVE
SAN DIEGO CA
92107-2902
US

IV. Provider business mailing address

4656 NARRAGANSETT AVE
SAN DIEGO CA
92107-2902
US

V. Phone/Fax

Practice location:
  • Phone: 619-519-3394
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1838
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: