Provider Demographics
NPI:1124110192
Name:RIORDAN, NOLLI SILVA (MD)
Entity type:Individual
Prefix:DR
First Name:NOLLI
Middle Name:SILVA
Last Name:RIORDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NOLLI
Other - Middle Name:KALAMA
Other - Last Name:SILVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1320 EL CAPITAN DR
Mailing Address - Street 2:STE 120
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-6260
Mailing Address - Country:US
Mailing Address - Phone:925-676-2600
Mailing Address - Fax:925-680-0212
Practice Address - Street 1:1002 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-2306
Practice Address - Country:US
Practice Address - Phone:510-521-6078
Practice Address - Fax:510-521-6079
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81855208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
BR238OtherMEDICARE PTAN