Provider Demographics
NPI:1487047809
Name:RIEGO, ARDY CABLING (ATC)
Entity type:Individual
Prefix:
First Name:ARDY
Middle Name:CABLING
Last Name:RIEGO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7250 MESA COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-4902
Mailing Address - Country:US
Mailing Address - Phone:619-388-2421
Mailing Address - Fax:619-388-2458
Practice Address - Street 1:7250 MESA COLLEGE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-4902
Practice Address - Country:US
Practice Address - Phone:619-388-2421
Practice Address - Fax:619-388-2458
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20000081682255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer