MEDICARE: ALICIA BERENICE RIOS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	95018021	CA
2	363LF0000X	Family Nurse Practitioner	95018021	CA

General Provider Information

NPI Number	:	1033885991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA BERENICE RIOS NP

Provider Business Mailing Address
First Line	:	68892 DURANGO RD
Second Line	:
City	:	CATHEDRAL CITY
State	:	CA
Zip	:	92234-3899
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1180 N INDIAN CANYON DR STE E420
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-4868
Country	:	US
Telephone Number	:	760-778-7147
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2021
Last Update Date	:	07/03/2023

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