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Individual

CORIE ZENOBIA RIDEAU

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
26511 THOROUGHBRED LN, MORENO VALLEY, CA 92555-2965
(951) 210-5144
Mailing address
26511 THOROUGHBRED LN, MORENO VALLEY, CA 92555-2965
(951) 210-5144

Taxonomy

Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
RDA93999
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
B5891651
CA
Enumeration date
10/28/2020
Last updated
10/28/2020
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