| Doctor Name: | MRS. GINA KIM RIEDL |
| NPI Number: | 1013095843 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPT |
| License Number: | 340077AN |
| Business Practice Address: | 8725 Watt Ave Antelope, CA - 958439747 |
| Business Phone Number: | 9163386449 |
| Business Fax Number: | 9163387535 |
| Mailing Address: | 2505 Muirfield Ct, LINCOLN |
| State: | CA |
| Postal Code: | 956482403 |
| Phone Number: | 9162235778 |
| Fax Number: | 9163387535 |
| NPI Enumeration Date: | 11/01/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 340077AN |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |