Provider Demographics
NPI:1871973560
Name:HADDAD RIDDLE, VICTORIA (DPT)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:HADDAD RIDDLE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:HADDAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10800 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3043
Mailing Address - Country:US
Mailing Address - Phone:951-353-4670
Mailing Address - Fax:909-478-9518
Practice Address - Street 1:10459 MOUNTAIN VIEW AVE
Practice Address - Street 2:SUITE G
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2033
Practice Address - Country:US
Practice Address - Phone:909-478-9508
Practice Address - Fax:909-478-9518
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61061225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ30106ZMedicare PIN
CACA167013Medicare PIN
CAZZZ23993ZMedicare PIN
CACA167014Medicare PIN