Provider Demographics
NPI:1093316192
Name:RIEGO, RAMON D JR
Entity Type:Individual
Prefix:MR
First Name:RAMON
Middle Name:D
Last Name:RIEGO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12371 LEWIS ST STE 202
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-4688
Mailing Address - Country:US
Mailing Address - Phone:657-667-0044
Mailing Address - Fax:657-263-4355
Practice Address - Street 1:12440 FIRESTONE BLVD STE 1025
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4369
Practice Address - Country:US
Practice Address - Phone:562-406-1028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA202028910634332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies