1679798730 NPI number — CHRISTINE RILEY R.D.

Table of content: CHRISTINE RILEY R.D. (NPI 1679798730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679798730 NPI number — CHRISTINE RILEY R.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RILEY
Provider First Name:
CHRISTINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679798730
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3006 S MARYLAND PKWY
Provider Second Line Business Mailing Address:
SUITE 690
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89109-2218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-732-1290
Provider Business Mailing Address Fax Number:
702-732-1385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
85 KIRMAN AVE
Provider Second Line Business Practice Location Address:
SUITE 401
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89502-1339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-324-6644
Provider Business Practice Location Address Fax Number:
775-324-3849
Provider Enumeration Date:
04/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  817350 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 817350 . This is a "RD LICENSE #" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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