Provider Demographics
NPI:1396513198
Name:RIANOMOJICA, ESTEBAN F
Entity type:Individual
Prefix:
First Name:ESTEBAN
Middle Name:F
Last Name:RIANOMOJICA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3275 BRAEBURN CIR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-2615
Mailing Address - Country:US
Mailing Address - Phone:734-249-4838
Mailing Address - Fax:
Practice Address - Street 1:2245 S STATE ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-6184
Practice Address - Country:US
Practice Address - Phone:734-769-0209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker