Healthcare Provider Details

I. General information

NPI: 1417362161
Provider Name (Legal Business Name): AMANDA RIES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR
SAN DIEGO CA
92134-5004
US

IV. Provider business mailing address

34800 BOB WILSON DR SAN DIEGO
SAN DIEGO CA
92134-0001
US

V. Phone/Fax

Practice location:
  • Phone: 619-723-1571
  • Fax: 858-203-0583
Mailing address:
  • Phone:
  • Fax: 858-203-0583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA138918
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberA138918
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: