Physician Compare National (NPI:1730566308)

HEALTHCARE PROVIDER: ELENA RIEDO PSY.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1730566308
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3678886595
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20150722003628
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	RIEDO
	Individual professional last name
Provider First Name	ELENA
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2005
	Individual professional's medical school graduation year
Primary Specialty	PSYCHOLOGIST, CLINICAL
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1723 E SOUTHLAKE BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 120
	Group Practice or individual's line 2 address
City	SOUTHLAKE
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	760926445
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8174374505
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y