Healthcare Provider Details

I. General information

NPI: 1265608608
Provider Name (Legal Business Name): PENINSULA INTEGRATIVE CARDIOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 CAMINO RAMON STE 208
SAN RAMON CA
94583-1392
US

IV. Provider business mailing address

2303 CAMINO RAMON STE 208
SAN RAMON CA
94583-1392
US

V. Phone/Fax

Practice location:
  • Phone: 650-447-6213
  • Fax: 866-406-6047
Mailing address:
  • Phone: 650-447-6213
  • Fax: 866-406-6047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberME93695
License Number StateFL

VIII. Authorized Official

Name: DANIEL RIEDERS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 650-447-6213