Provider Demographics
NPI:1548486525
Name:RISSER, DONALD J (LAC MTOM)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:J
Last Name:RISSER
Suffix:
Gender:M
Credentials:LAC MTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 1198
Mailing Address - Street 2:
Mailing Address - City:JOSHUA TREE
Mailing Address - State:CA
Mailing Address - Zip Code:92252-9728
Mailing Address - Country:US
Mailing Address - Phone:760-228-2644
Mailing Address - Fax:
Practice Address - Street 1:7211 JOSHUA LN
Practice Address - Street 2:SUITE #5
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-2937
Practice Address - Country:US
Practice Address - Phone:760-228-2644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6466171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist