Provider Demographics
NPI:1053919266
Name:RILEY, DARAVIEN SR
Entity type:Individual
Prefix:
First Name:DARAVIEN
Middle Name:
Last Name:RILEY
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 SE SWYGART ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66605-1770
Mailing Address - Country:US
Mailing Address - Phone:785-596-5008
Mailing Address - Fax:
Practice Address - Street 1:2105 SE SWYGART ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66605-1770
Practice Address - Country:US
Practice Address - Phone:785-596-5008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)