Provider Demographics
NPI:1497346993
Name:KIERSTEN L RIEDLER MD CORP
Entity type:Organization
Organization Name:KIERSTEN L RIEDLER MD CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIERSTEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:RIEDLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-882-7504
Mailing Address - Street 1:11244 VISTA SORRENTO PKWY APT 210
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-7629
Mailing Address - Country:US
Mailing Address - Phone:858-882-7504
Mailing Address - Fax:
Practice Address - Street 1:9850 GENESEE AVE STE 130
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1206
Practice Address - Country:US
Practice Address - Phone:858-452-1981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty