Provider Demographics
NPI:1467098384
Name:RIDDLE, DAWN
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:RIDDLE
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 1:75 DIAMOND VALLEY RD UNIT C
Mailing Address - Street 2:
Mailing Address - City:MARKLEEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96120-9579
Mailing Address - Country:US
Mailing Address - Phone:530-694-1816
Mailing Address - Fax:530-694-2387
Practice Address - Street 1:75 DIAMOND VALLEY RD UNIT C
Practice Address - Street 2:
Practice Address - City:MARKLEEVILLE
Practice Address - State:CA
Practice Address - Zip Code:96120-9579
Practice Address - Country:US
Practice Address - Phone:530-694-1816
Practice Address - Fax:530-694-2387
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator