Provider Demographics
NPI:1174537435
Name:RIYANTO QUEMENA DPM INC
Entity type:Organization
Organization Name:RIYANTO QUEMENA DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RIYANTO
Authorized Official - Middle Name:
Authorized Official - Last Name:QUEMENA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:626-576-2900
Mailing Address - Street 1:841 W VALLEY BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-3251
Mailing Address - Country:US
Mailing Address - Phone:626-576-2900
Mailing Address - Fax:626-576-3968
Practice Address - Street 1:841 W VALLEY BLVD STE 102
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-3251
Practice Address - Country:US
Practice Address - Phone:626-576-2900
Practice Address - Fax:626-576-3968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2792213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E27920Medicaid
CA000E27920Medicaid
CAT19237Medicare UPIN
CAT19237Medicare UPIN