=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679940845
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JO DEIGH RIGGS R.N.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2015
-----------------------------------------------------
Last Update Date | 08/24/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7200 BANCROFT AVE
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94605-2403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-746-5570
-----------------------------------------------------
Fax | 510-553-1099
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 395 OYSTER POINT BLVD STE 202
-----------------------------------------------------
City | SOUTH SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94080-1929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-758-4700
-----------------------------------------------------
Fax | 866-758-4711
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 470352
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------