Provider Demographics
NPI:1689313983
Name:TODICHEENEY, RYDELL L (PHD, APRN, ACNS-BC)
Entity Type:Individual
Prefix:DR
First Name:RYDELL
Middle Name:L
Last Name:TODICHEENEY
Suffix:
Gender:M
Credentials:PHD, APRN, ACNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 YOSEMITE ST
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:CA
Mailing Address - Zip Code:93955-5634
Mailing Address - Country:US
Mailing Address - Phone:602-315-1315
Mailing Address - Fax:
Practice Address - Street 1:1305 YOSEMITE ST
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:CA
Practice Address - Zip Code:93955-5634
Practice Address - Country:US
Practice Address - Phone:602-315-1315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7305364S00000X
CA2819364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist