Healthcare Provider Details

I. General information

NPI: 1457330797
Provider Name (Legal Business Name): JETHRO TREES RITTER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 BISHOP ST STE 250
SAN LUIS OBISPO CA
93401-4661
US

IV. Provider business mailing address

PO BOX 1206
GOLETA CA
93116-1206
US

V. Phone/Fax

Practice location:
  • Phone: 805-540-0689
  • Fax: 805-541-4376
Mailing address:
  • Phone: 805-540-0689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number20A8407
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: