Provider Demographics
NPI:1750544516
Name:RIES, MAUREEN CHRISTIE (MD)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:CHRISTIE
Last Name:RIES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MAUREEN
Other - Middle Name:CHRISTIE
Other - Last Name:LOA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 232410
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-2410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9000
Practice Address - Country:US
Practice Address - Phone:858-657-8745
Practice Address - Fax:858-657-8666
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA127234207V00000X
OH35.099009207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0066528Medicaid
WV3810023292Medicaid
OHH101020Medicare PIN