Active NPI
Corine Michelle Riedell, PA-C
- Physician Assistant
- Ventura, CA
National Provider Identifier
1871870626
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA21988
- Practice address
- 200 S Wells Rd
Ventura, CA 93004-1377 - Phone
- (805) 659-1740
- Fax
- (805) 659-1740
- NPI assigned
- Nov 8, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA21988 | CA | Primary |
Addresses
Primary practice location
200 S Wells Rd
Ventura, CA 93004-1377
Mailing address
200 S Wells Rd
Ventura, CA 93004-1377
Phone (805) 659-1740
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21988 | CA | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1320710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1367366400000",
"number": "1871870626",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 S WELLS RD",
"city": "VENTURA",
"state": "CA",
"postal_code": "930041377",
"telephone_number": "805-659-1740",
"fax_number": "805-659-1740"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 S WELLS RD",
"city": "VENTURA",
"state": "CA",
"postal_code": "930041377",
"telephone_number": "805-659-1740",
"fax_number": "805-659-1740"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIEDELL",
"first_name": "CORINE",
"middle_name": "MICHELLE",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-11-08",
"last_updated": "2013-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA21988",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ventura, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.