Provider Demographics
NPI:1386785566
Name:OVERTURF, RIETTA LYNNE (PHD)
Entity type:Individual
Prefix:DR
First Name:RIETTA
Middle Name:LYNNE
Last Name:OVERTURF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22784 RUNNING RABBIT COURT
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92587
Mailing Address - Country:US
Mailing Address - Phone:951-244-0156
Mailing Address - Fax:951-443-2240
Practice Address - Street 1:1688 N PERRIS BLVD
Practice Address - Street 2:SUITES L7 TO L11
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571
Practice Address - Country:US
Practice Address - Phone:951-443-2222
Practice Address - Fax:951-443-2240
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13014103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist