Provider Demographics
NPI:1356683551
Name:RILEY, ANTHONY BRUCE (MD, JD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:BRUCE
Last Name:RILEY
Suffix:
Gender:M
Credentials:MD, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:433 ESTUDILLO AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4915
Mailing Address - Country:US
Mailing Address - Phone:510-969-4166
Mailing Address - Fax:510-969-5530
Practice Address - Street 1:433 ESTUDILLO AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4915
Practice Address - Country:US
Practice Address - Phone:510-969-4166
Practice Address - Fax:510-969-5530
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG62098208D00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine