Provider Demographics
NPI:1497073472
Name:RILEY, ALFONZA JULIUS (RVS)
Entity Type:Individual
Prefix:MR
First Name:ALFONZA
Middle Name:JULIUS
Last Name:RILEY
Suffix:
Gender:M
Credentials:RVS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8162 FENWICK CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5618
Mailing Address - Country:US
Mailing Address - Phone:888-831-4969
Mailing Address - Fax:888-831-4969
Practice Address - Street 1:8162 FENWICK CT
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5618
Practice Address - Country:US
Practice Address - Phone:888-831-4969
Practice Address - Fax:888-831-4969
Is Sole Proprietor?:No
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR131048163WI0500X, 163WP0000X
DCRN66423163WI0500X, 163WP0000X
MD000699022471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WP0000XNursing Service ProvidersRegistered NursePain Management