Provider Demographics
NPI:1689712242
Name:RILEY-GARNER, ROBIN DEANNA (PA)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:DEANNA
Last Name:RILEY-GARNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4353 DAWN AVE
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-2812
Mailing Address - Country:US
Mailing Address - Phone:909-596-7474
Mailing Address - Fax:310-673-5307
Practice Address - Street 1:3215 W IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-2810
Practice Address - Country:US
Practice Address - Phone:310-677-3595
Practice Address - Fax:310-673-5307
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14869363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical