Provider Demographics
NPI:1679798730
Name:RILEY, CHRISTINE (RD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 S MARYLAND PKWY
Mailing Address - Street 2:SUITE 690
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2218
Mailing Address - Country:US
Mailing Address - Phone:702-732-1290
Mailing Address - Fax:702-732-1385
Practice Address - Street 1:85 KIRMAN AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1339
Practice Address - Country:US
Practice Address - Phone:775-324-6644
Practice Address - Fax:775-324-3849
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT817350133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV817350OtherRD LICENSE #