Provider Demographics
NPI:1407293822
Name:RIESTRA, NORMA ELIZABETH
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:ELIZABETH
Last Name:RIESTRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 RIDGECREST TER
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3997
Mailing Address - Country:US
Mailing Address - Phone:510-731-7369
Mailing Address - Fax:
Practice Address - Street 1:90 GREAT OAKS BLVD
Practice Address - Street 2:108
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1314
Practice Address - Country:US
Practice Address - Phone:408-281-0708
Practice Address - Fax:408-281-2658
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2013-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor