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General NPI Number Information
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NPI Number | 1760336481
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Entity Type | Individual
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Provider Name | JEROME RILEY
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Gender | Male
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Dates
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Enumeration Date | 02/21/2026
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Last Update Date | 02/21/2026
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Provider Practice Location Address
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Address Line | 5401 CHIMNEY ROCK RD
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City | HOUSTON
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State | TX
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Zip | 77081-2004
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Country | US
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Telephone | 832-379-2335
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Fax |
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Provider Business Mailing Address
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Address Line | 5401 CHIMNEY ROCK RD APT 249
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City | HOUSTON
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State | TX
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Zip | 77081-2045
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Country | US
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Telephone | 832-379-2335
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 22100284
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License Number State | TX
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