Basic Information
| Provider Information | |||||||||
| NPI: | 1386771517 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANRIPER | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | CHARLES | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DPT, ATC, CSCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1235 W TOWN AND COUNTRY RD | ||||||||
| Address2: | #1406 | ||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928684611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145044376 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6177 RIVER CREST DR STE A | ||||||||
| Address2: | MCCUE CENTER 800 MASSIE ROAD | ||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925070728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516534480 | ||||||||
| FaxNumber: | 9516535051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 01/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer | 225100000X | 38460 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.