Healthcare Provider Details

I. General information

NPI: 1619040227
Provider Name (Legal Business Name): JOHN W RIORDAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOHN WILLIAM RIORDAN II M.D.

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WEBSTER ST SUITE 320
SAN FRANCISCO CA
94115-2377
US

IV. Provider business mailing address

2100 WEBSTER ST SUITE 320
SAN FRANCISCO CA
94115-2377
US

V. Phone/Fax

Practice location:
  • Phone: 415-923-3815
  • Fax: 415-749-5713
Mailing address:
  • Phone: 415-923-3815
  • Fax: 415-749-5713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA52155
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: