Healthcare Provider Details

I. General information

NPI: 1497227250
Provider Name (Legal Business Name): RACHEL RILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2018
Last Update Date: 09/13/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 RIO GRANDE BLVD NW
ALBUQUERQUE NM
87104-2529
US

IV. Provider business mailing address

2012 MADEIRA DR NE
ALBUQUERQUE NM
87110-5140
US

V. Phone/Fax

Practice location:
  • Phone: 505-830-1871
  • Fax:
Mailing address:
  • Phone: 505-903-9954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2023-0598
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: