Provider Demographics
NPI:1750484754
Name:RILEY, JAMES EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWARD
Last Name:RILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:528 CAPITOLA AVE
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2750
Mailing Address - Country:US
Mailing Address - Phone:831-475-1630
Mailing Address - Fax:831-475-1629
Practice Address - Street 1:528 CAPITOLA AVE
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2750
Practice Address - Country:US
Practice Address - Phone:831-475-1630
Practice Address - Fax:831-475-1629
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63461207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0028553OtherMEDI-CAL ID NUMBER
CAH05576Medicare UPIN
CAZZZ20178ZMedicare ID - Type UnspecifiedMEDICARE ID NUMBER