Healthcare Provider Details

I. General information

NPI: 1912942137
Provider Name (Legal Business Name): RICHARD LEE RILEY CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RICHARD LEE RILEY CP

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 US HIGHWAY 395 N SUITE 303
CARSON CITY NV
89704-9582
US

IV. Provider business mailing address

220 US HIGHWAY 395 N SUITE 303
CARSON CITY NV
89704-9582
US

V. Phone/Fax

Practice location:
  • Phone: 775-830-1783
  • Fax:
Mailing address:
  • Phone: 775-830-1783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberCP 1356
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: