Provider Demographics
NPI:1619751807
Name:RILEY, KHADIJA ALISHA
Entity Type:Individual
Prefix:
First Name:KHADIJA
Middle Name:ALISHA
Last Name:RILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 N ONTARIO ST APT C
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-3603
Mailing Address - Country:US
Mailing Address - Phone:567-901-8735
Mailing Address - Fax:
Practice Address - Street 1:1907 HOMER AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-1634
Practice Address - Country:US
Practice Address - Phone:567-901-8735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health