Provider Demographics
NPI:1467483735
Name:RICE, DAVID COLTON (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:COLTON
Last Name:RICE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4535
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-6535
Mailing Address - Country:US
Mailing Address - Phone:707-557-9202
Mailing Address - Fax:510-558-9943
Practice Address - Street 1:801 E 2ND ST
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-3347
Practice Address - Country:US
Practice Address - Phone:707-557-9202
Practice Address - Fax:510-558-9943
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4578103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL45780Medicare ID - Type Unspecified
CAR25993Medicare UPIN