MEDICARE: DEON UNDREA RIDGELL

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1285593145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEON UNDREA RIDGELL

Provider Business Mailing Address
First Line	:	1311 PARK ST # 1029
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-4507
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1311 PARK ST # 1029
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-4507
Country	:	US
Telephone Number	:	504-858-0526
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2026
Last Update Date	:	01/16/2026

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Directions to “ DEON UNDREA RIDGELL ” Practice Location

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