Healthcare Provider Details

I. General information

NPI: 1356802128
Provider Name (Legal Business Name): J TREES RITTER D.O., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 PEACH ST STE M
SAN LUIS OBISPO CA
93401-2877
US

IV. Provider business mailing address

PO BOX 1206
GOLETA CA
93116-1206
US

V. Phone/Fax

Practice location:
  • Phone: 805-540-0689
  • Fax:
Mailing address:
  • Phone: 805-964-3838
  • Fax: 805-638-3400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JETHRO TREES RITTER
Title or Position: PRESIDENT
Credential: DO
Phone: 805-305-5296