Provider Demographics
NPI:1164500021
Name:RIEDL, ROBERT KENNETH II (PHD,M- RAS, MCA)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KENNETH
Last Name:RIEDL
Suffix:II
Gender:M
Credentials:PHD,M- RAS, MCA
Other - Prefix:DR
Other - First Name:KEN
Other - Middle Name:KEN
Other - Last Name:RIEDL
Other - Suffix:II
Other - Last Name Type:Other Name
Other - Credentials:PHD,M- RAS, MCA
Mailing Address - Street 1:2055 SAVIERS RD
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-3608
Mailing Address - Country:US
Mailing Address - Phone:805-483-2253
Mailing Address - Fax:
Practice Address - Street 1:2055 SAVIERS RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-3608
Practice Address - Country:US
Practice Address - Phone:805-483-2253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103211032101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA103211032OtherREGITERED ADDICTION SPEC