Healthcare Provider Details

I. General information

NPI: 1134329162
Provider Name (Legal Business Name): DARREN MAXWELL RIESZ L.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 TURK ST
SAN FRANCISCO CA
94102-3118
US

IV. Provider business mailing address

3124 21ST ST
SAN FRANCISCO CA
94110-2564
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-5050
  • Fax:
Mailing address:
  • Phone: 415-652-6967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number30490
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: