Provider Demographics
NPI:1134329162
Name:RIESZ, DARREN MAXWELL (LPT)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:MAXWELL
Last Name:RIESZ
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3124 21ST ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2564
Mailing Address - Country:US
Mailing Address - Phone:415-652-6967
Mailing Address - Fax:
Practice Address - Street 1:888 TURK ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-3118
Practice Address - Country:US
Practice Address - Phone:415-353-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30490167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician