Healthcare Provider Details

I. General information

NPI: 1013825231
Provider Name (Legal Business Name): RIBOH HEALTH & WELLNESS PHYSICIAN ASSISTANT PROFESSIONAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 ETIWANDA AVE STE 313
TARZANA CA
91356-6127
US

IV. Provider business mailing address

5525 ETIWANDA AVE STE 313
TARZANA CA
91356-6127
US

V. Phone/Fax

Practice location:
  • Phone: 818-321-9999
  • Fax:
Mailing address:
  • Phone: 818-321-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DANIEL RIBOH
Title or Position: PRESIDENT
Credential: PA-C
Phone: 818-321-9999