Provider Demographics
NPI:1265608608
Name:PENINSULA INTEGRATIVE CARDIOLOGY, PC
Entity type:Organization
Organization Name:PENINSULA INTEGRATIVE CARDIOLOGY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RIEDERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-447-6213
Mailing Address - Street 1:2303 CAMINO RAMON STE 208
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1392
Mailing Address - Country:US
Mailing Address - Phone:650-447-6213
Mailing Address - Fax:866-406-6047
Practice Address - Street 1:2303 CAMINO RAMON STE 208
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1392
Practice Address - Country:US
Practice Address - Phone:650-447-6213
Practice Address - Fax:866-406-6047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93695207RC0001X
207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty