Provider Demographics
NPI:1952672487
Name:RIORDAN, KATHY P (PT ASSISTANT)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:P
Last Name:RIORDAN
Suffix:
Gender:F
Credentials:PT ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 BUENA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94801-4026
Mailing Address - Country:US
Mailing Address - Phone:415-203-9668
Mailing Address - Fax:
Practice Address - Street 1:211 BUENA VISTA AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801-4026
Practice Address - Country:US
Practice Address - Phone:415-203-9668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 2044314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility