Provider Demographics
NPI:1699596189
Name:RIDDERBUSCH, VENA MARIE
Entity type:Individual
Prefix:
First Name:VENA
Middle Name:MARIE
Last Name:RIDDERBUSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 COTTONWOOD AVE # 60
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92582-4748
Mailing Address - Country:US
Mailing Address - Phone:909-449-3842
Mailing Address - Fax:
Practice Address - Street 1:3440 COTTONWOOD AVE # 60
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92582-4748
Practice Address - Country:US
Practice Address - Phone:909-449-3842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician