Provider Demographics
NPI:1225365778
Name:CANNAMED RELIEF
Entity Type:Organization
Organization Name:CANNAMED RELIEF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICEPRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:RIDDICK
Authorized Official - Suffix:
Authorized Official - Credentials:HEALTH CARE GIVER
Authorized Official - Phone:951-682-3969
Mailing Address - Street 1:22426 WEMBLEY DR
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-6828
Mailing Address - Country:US
Mailing Address - Phone:951-682-3969
Mailing Address - Fax:951-682-3969
Practice Address - Street 1:21016 BOX SPRINGS RD
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-8711
Practice Address - Country:US
Practice Address - Phone:951-204-4016
Practice Address - Fax:951-682-3969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA330015118347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle