MEDICARE: RISE RESOURCE CENTER LLC

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	207QP0002X	Physician Nutrition Specialist (Family Medicine)
2	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1790613115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISE RESOURCE CENTER LLC

Provider Business Mailing Address
First Line	:	6955 N DURANGO DR
Second Line	:	1115-274
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4485
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6955 N DURANGO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4485
Country	:	US
Telephone Number	:	702-885-1441
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	AMIYNA WASHINGTON
Credential	:
Telephone Number	:	702-885-1441

Provider Enumeration Date	:	05/13/2026
Last Update Date	:	05/13/2026

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