Healthcare Provider Details

I. General information

NPI: 1255925202
Provider Name (Legal Business Name): ALEXANDRIA LEIGH RIDLING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2021
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2290 SACRAMENTO ST
VALLEJO CA
94590-2929
US

IV. Provider business mailing address

3320 MACBETH ST
NAPA CA
94558-3118
US

V. Phone/Fax

Practice location:
  • Phone: 707-643-5785
  • Fax: 707-643-8190
Mailing address:
  • Phone: 707-337-5227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: