Provider Demographics
NPI:1932127602
Name:RIPPNER, ROBERT STEVEN
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:STEVEN
Last Name:RIPPNER
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 1:12700 CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-8328
Mailing Address - Country:US
Mailing Address - Phone:530-895-0926
Mailing Address - Fax:
Practice Address - Street 1:1902 ROYALTY DR STE 220
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3056
Practice Address - Country:US
Practice Address - Phone:530-895-0926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG373142085R0202X
TXTM003062085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG37314OtherSTATE LICENSE
CAE24975Medicare UPIN
CA00G373142Medicare PIN