Provider Demographics
NPI:1487232054
Name:COOK, RILEY (RDN)
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:NAIA
Other - Middle Name:RILEY
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDN
Mailing Address - Street 1:29025 VIEW DR
Mailing Address - Street 2:
Mailing Address - City:AGOURA
Mailing Address - State:CA
Mailing Address - Zip Code:91301-2945
Mailing Address - Country:US
Mailing Address - Phone:818-585-9076
Mailing Address - Fax:
Practice Address - Street 1:6049 FAIRLANE DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-1805
Practice Address - Country:US
Practice Address - Phone:818-585-9076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86087917133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered