MEDICARE: ELIZABETH RIOS RD

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	133V00000X	Registered Dietitian	DT07343	TX

General Provider Information

NPI Number	:	1215276464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH RIOS RD

Provider Business Mailing Address
First Line	:	7121 SOUTH PADRE ISLAND DRIVE
Second Line	:
City	:	CORPUS CHRISTI
State	:	USA
Zip	:	78413
Country	:	UM
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4441 LAKE GEORGE DR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78413-4362
Country	:	US
Telephone Number	:	361-290-0781
Fax Number	:	877-320-9707

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

Provider Enumeration Date	:	02/07/2013
Last Update Date	:	05/02/2022

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