Provider Demographics
NPI:1245039825
Name:RIEDINGER, MARY S (PHD, AGNP-C)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:S
Last Name:RIEDINGER
Suffix:
Gender:
Credentials:PHD, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 N SEPULVEDA BLVD # 210
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-2185
Mailing Address - Country:US
Mailing Address - Phone:424-273-5770
Mailing Address - Fax:
Practice Address - Street 1:651 N SEPULVEDA BLVD # 210
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-2185
Practice Address - Country:US
Practice Address - Phone:424-273-5770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95034163363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology