Basic Information
| Provider Information | |||||||||
| NPI: | 1487859500 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RILEY | ||||||||
| FirstName: | ALYSSA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 COFFEE RD | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953554201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095216097 | ||||||||
| FaxNumber: | 2095214081 | ||||||||
| Practice Location | |||||||||
| Address1: | 2505 W HAMMER LN | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952092839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2099577050 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2007 | ||||||||
| LastUpdateDate: | 10/30/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 35.089970 | OH | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | A132399 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0210X | N9122 | TX | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Nephrology |
No ID Information.