Basic Information
| Provider Information | |||||||||
| NPI: | 1790189678 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RILEY | ||||||||
| FirstName: | MAURIO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 PALMETTO HEALTH PKWY STE 104 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292121754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037824278 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 PALMETTO HEALTH PKWY STE 104 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292121754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8030000000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2014 | ||||||||
| LastUpdateDate: | 09/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 2211 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.