Provider Demographics
NPI:1497536791
Name:RIRIE, PHYLENE
Entity Type:Individual
Prefix:
First Name:PHYLENE
Middle Name:
Last Name:RIRIE
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 1:5129 LONE TREE WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8484
Mailing Address - Country:US
Mailing Address - Phone:925-383-4810
Mailing Address - Fax:925-226-0812
Practice Address - Street 1:9671 DEER VALLEY RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-4907
Practice Address - Country:US
Practice Address - Phone:925-383-4810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-12
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility