Provider Demographics
NPI:1700835998
Name:QUEMENA, RIYANTO (DPM)
Entity Type:Individual
Prefix:
First Name:RIYANTO
Middle Name:
Last Name:QUEMENA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:RAY
Other - Middle Name:
Other - Last Name:QUEMENA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:841 W VALLEY BLVD
Mailing Address - Street 2:SUITE#102
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-3251
Mailing Address - Country:US
Mailing Address - Phone:626-576-2900
Mailing Address - Fax:626-576-3968
Practice Address - Street 1:841 W VALLEY BLVD
Practice Address - Street 2:SUITE#102
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-3251
Practice Address - Country:US
Practice Address - Phone:626-576-2900
Practice Address - Fax:626-576-3968
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2792213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E27920Medicaid
CA000E27920Medicaid
CAE2792Medicare ID - Type Unspecified