MEDICARE: PENINSULA INTEGRATIVE CARDIOLOGY, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0001X	Clinical Cardiac Electrophysiology Physician	ME93695	FL
2	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1265608608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENINSULA INTEGRATIVE CARDIOLOGY, PC

Provider Business Mailing Address
First Line	:	2303 CAMINO RAMON STE 208
Second Line	:
City	:	SAN RAMON
State	:	CA
Zip	:	94583-1392
Country	:	US
Telephone Number	:	650-447-6213
Fax Number	:	866-406-6047

Provider Business Practice Location Address
First Line	:	2303 CAMINO RAMON STE 208
Second Line	:
City	:	SAN RAMON
State	:	CA
Zip	:	94583-1392
Country	:	US
Telephone Number	:	650-447-6213
Fax Number	:	866-406-6047

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANIEL RIEDERS
Credential	:	M.D.
Telephone Number	:	650-447-6213

Provider Enumeration Date	:	05/06/2008
Last Update Date	:	01/03/2023

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