Healthcare Provider Details

I. General information

NPI: 1659363141
Provider Name (Legal Business Name): VELISAR L RILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 PRINGLE WAY SUITE 401
RENO NV
89502-1464
US

IV. Provider business mailing address

75 PRINGLE WAY SUITE 401
RENO NV
89502-1464
US

V. Phone/Fax

Practice location:
  • Phone: 775-688-8000
  • Fax: 775-688-8031
Mailing address:
  • Phone: 775-688-8000
  • Fax: 775-688-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number10524
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA84369
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number48734
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: