Provider Demographics
NPI:1174936645
Name:YOUNGBLOOD, RIAN
Entity type:Individual
Prefix:
First Name:RIAN
Middle Name:
Last Name:YOUNGBLOOD
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:PO BOX 363701
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89036-7701
Mailing Address - Country:US
Mailing Address - Phone:918-360-5552
Mailing Address - Fax:
Practice Address - Street 1:6551 MCCARRAN ST
Practice Address - Street 2:3044
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086-1435
Practice Address - Country:US
Practice Address - Phone:918-360-5552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner