Provider Demographics
NPI:1720241474
Name:RIDAY, MARIBETH (RN, MSN, RDH)
Entity type:Individual
Prefix:
First Name:MARIBETH
Middle Name:
Last Name:RIDAY
Suffix:
Gender:F
Credentials:RN, MSN, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 EMELINE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-1976
Mailing Address - Country:US
Mailing Address - Phone:831-454-4170
Mailing Address - Fax:831-454-4663
Practice Address - Street 1:1430 FREEDOM BLVD STE B
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2780
Practice Address - Country:US
Practice Address - Phone:831-763-8200
Practice Address - Fax:831-454-4663
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA697504163W00000X
CA18870363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ91891ZOtherSANTA CRUZ COUNTY MEDICARE GROUP PTAN#
CA2012001567OtherANCC B CERTIFICATION#
CAZZZ92069ZOtherSANTA CRUZ COUNTY MEDICARE GROUP PTAN#
CA18870OtherNURSE PRACTITIONER FURNISHING LICENSE
CAZZZ91892ZOtherSANTA CRUZ COUNTY MEDICARE GROUP PTAN#
CAFHC40044FOtherSANTA CRUZ COUNTY MEDICAID GROUP NUMBER
CA2012001567OtherANCC B CERTIFICATION#
CACA148810Medicare PIN
CACA148811Medicare PIN