Provider Demographics
NPI:1215658331
Name:RIGGS, PROVIDENCE JANELLE (BA, CLINICAL INTERN)
Entity type:Individual
Prefix:
First Name:PROVIDENCE
Middle Name:JANELLE
Last Name:RIGGS
Suffix:
Gender:F
Credentials:BA, CLINICAL INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 E MEDA AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-2622
Mailing Address - Country:US
Mailing Address - Phone:626-384-0335
Mailing Address - Fax:
Practice Address - Street 1:2116 ARLINGTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-1353
Practice Address - Country:US
Practice Address - Phone:323-334-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program