MEDICARE: RILEY MOHR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	247200000X	Other Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255949822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RILEY MOHR

Provider Business Mailing Address
First Line	:	5511 RAINBOW CIR
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95409-4377
Country	:	US
Telephone Number	:	707-328-0752
Fax Number	:

Provider Business Practice Location Address
First Line	:	5511 RAINBOW CIR
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95409-4377
Country	:	US
Telephone Number	:	707-328-0752
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2020
Last Update Date	:	07/20/2020

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