Healthcare Provider Details

I. General information

NPI: 1639180276
Provider Name (Legal Business Name): RIFLEY INSTITUTE OF COSMETIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 N TENAYA WAY STE 201
LAS VEGAS NV
89128-0652
US

IV. Provider business mailing address

2800 N TENAYA WAY STE 201
LAS VEGAS NV
89128-0652
US

V. Phone/Fax

Practice location:
  • Phone: 702-242-4616
  • Fax: 702-243-9219
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number7465
License Number StateNV

VIII. Authorized Official

Name: WILLIAM RIFLEY
Title or Position: MEDICAL DIRECTOR
Credential: NMI
Phone: 702-242-4616