Healthcare Provider Details

I. General information

NPI: 1679772867
Provider Name (Legal Business Name): J TREES RITTER, DO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
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: 805-541-1376
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: J TREES RITTER
Title or Position: PRESIDENT
Credential: D.O.
Phone: 805-305-5296