Individual
JACOB WAYNE RIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1140 W LA VETA AVE STE 860, ORANGE, CA 92868-4218
(714) 835-6500
Mailing address
1140 W LA VETA AVE STE 860, ORANGE, CA 92868-4218
(714) 835-6500
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA55464
CA
Other
Enumeration date
03/29/2018
Last updated
03/29/2018
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