Provider Demographics
NPI:1386764595
Name:RIKER, BETSY (PA)
Entity type:Individual
Prefix:MS
First Name:BETSY
Middle Name:
Last Name:RIKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-4929
Mailing Address - Country:US
Mailing Address - Phone:831-359-0522
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF CALIFORNIA SANTA CRUZ STUDENT HEALTH
Practice Address - Street 2:1156 HIGH ST
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95064
Practice Address - Country:US
Practice Address - Phone:831-459-3545
Practice Address - Fax:831-459-3546
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12629363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant