MEDICARE: CARMELO V RILLERA MD

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	207Q00000X	Family Medicine Physician	5972	NV

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	:	1467425421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMELO V RILLERA MD

Provider Business Mailing Address
First Line	:	2200 PASEO VERDE PKWY STE 260
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-2703
Country	:	US
Telephone Number	:	702-616-5801
Fax Number	:

Provider Business Practice Location Address
First Line	:	8205 W WARM SPRINGS RD STE 210
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-3646
Country	:	US
Telephone Number	:	702-616-5801
Fax Number	:

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

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	10/24/2017

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