Healthcare Provider Details

I. General information

NPI: 1912551383
Provider Name (Legal Business Name): CHERISE LOUISE RILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 05/16/2021
Certification Date: 05/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 PICACHO RD
WINTERHAVEN CA
92283-9605
US

IV. Provider business mailing address

PO BOX 1368
YUMA AZ
85366-2361
US

V. Phone/Fax

Practice location:
  • Phone: 760-572-4811
  • Fax: 760-572-4228
Mailing address:
  • Phone: 760-572-4100
  • Fax: 760-572-4228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH008657
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: