Provider Demographics
NPI:1750663126
Name:RIDING, BRIAN R (MS, PA-C)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:R
Last Name:RIDING
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Gender:M
Credentials:MS, PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11160 WARNER AVE
Mailing Address - Street 2:SUITE 311
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4008
Mailing Address - Country:US
Mailing Address - Phone:714-850-7300
Mailing Address - Fax:714-850-7310
Practice Address - Street 1:11160 WARNER AVE
Practice Address - Street 2:SUITE 311
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4008
Practice Address - Country:US
Practice Address - Phone:714-850-7300
Practice Address - Fax:714-850-7310
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2021-11-30
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Provider Licenses
StateLicense IDTaxonomies
CA21812363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant