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General NPI Number Information
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NPI Number | 1992917108
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Entity Type | Organization
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Legal Business Name | JEFFREY D RIES D O A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 07/27/2012
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Provider Practice Location Address
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Address Line | 1310 SAN BERNARDINO RD STE 101
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City | UPLAND
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State | CA
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Zip | 91786-4985
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Country | US
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Telephone | 909-579-0779
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Fax | 909-579-0789
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Provider Business Mailing Address
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Address Line | 1310 SAN BERNARDINO RD SUITE 101
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City | UPLAND
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State | CA
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Zip | 91786-4979
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Country | US
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Telephone | 909-579-0779
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Fax | 909-579-0789
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY DEAN RIES
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Credential | D O
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Telephone | 909-579-0779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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