Provider Demographics
NPI:1932201670
Name:VON RIOTTE, ALISA BLOUNT (MD)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:BLOUNT
Last Name:VON RIOTTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 270
Mailing Address - Street 2:RAMPTON II, SOUTHEAST UNIT
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84603-0270
Mailing Address - Country:US
Mailing Address - Phone:801-344-4400
Mailing Address - Fax:801-344-4325
Practice Address - Street 1:1300 E CENTER ST
Practice Address - Street 2:SOUTHEAST UNIT
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-3554
Practice Address - Country:US
Practice Address - Phone:801-344-4400
Practice Address - Fax:801-344-4325
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT35982412052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry