Healthcare Provider Details

I. General information

NPI: 1578165734
Provider Name (Legal Business Name): RIDER MOBILITY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 03/08/2024
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5735 KEARNY VILLA RD STE 111
SAN DIEGO CA
92123-1138
US

IV. Provider business mailing address

3985 W CHEYENNE AVE STE 306
NORTH LAS VEGAS NV
89032-8907
US

V. Phone/Fax

Practice location:
  • Phone: 858-598-5505
  • Fax: 858-598-5508
Mailing address:
  • Phone: 702-272-0230
  • Fax: 702-272-0289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: KIRSTEN WENDER
Title or Position: PRESIDENT
Credential: ATP
Phone: 702-272-0230