Provider Demographics
NPI:1639305410
Name:RITTER, ROBERTA (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:RITTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:
Other - Last Name:RITTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:29160 HEATHERCLIFF RD
Mailing Address - Street 2:4090 FL1
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-6315
Mailing Address - Country:US
Mailing Address - Phone:310-457-5810
Mailing Address - Fax:310-457-5810
Practice Address - Street 1:29160 HEATHERCLIFF RD
Practice Address - Street 2:4090 FL1
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-6315
Practice Address - Country:US
Practice Address - Phone:310-457-5810
Practice Address - Fax:310-457-5810
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-07
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG24775173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine