Provider Demographics
NPI:1174010052
Name:RICIOLI, JOSEPH (DO (MAY 30, 2018))
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:RICIOLI
Suffix:
Gender:M
Credentials:DO (MAY 30, 2018)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E ST
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:CA
Mailing Address - Zip Code:95363-2670
Mailing Address - Country:US
Mailing Address - Phone:209-892-2081
Mailing Address - Fax:209-892-5978
Practice Address - Street 1:801 E ST
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:CA
Practice Address - Zip Code:95363-2670
Practice Address - Country:US
Practice Address - Phone:209-892-2081
Practice Address - Fax:209-892-5978
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A19137207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine