Healthcare Provider Details

I. General information

NPI: 1992917108
Provider Name (Legal Business Name): JEFFREY D RIES D O A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 SAN BERNARDINO RD STE 101
UPLAND CA
91786-4985
US

IV. Provider business mailing address

1310 SAN BERNARDINO RD SUITE 101
UPLAND CA
91786-4979
US

V. Phone/Fax

Practice location:
  • Phone: 909-579-0779
  • Fax: 909-579-0789
Mailing address:
  • Phone: 909-579-0779
  • Fax: 909-579-0789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY DEAN RIES
Title or Position: PRESIDENT
Credential: D O
Phone: 909-579-0779