MEDICARE: MICHELLE RIOS RICE MSW

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	174400000X	Specialist	X06366	NM

General Provider Information

NPI Number	:	1376790931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE RIOS RICE MSW

Provider Business Mailing Address
First Line	:	2916 CALLE DERECHA
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-6530
Country	:	US
Telephone Number	:	505-471-0038
Fax Number	:

Provider Business Practice Location Address
First Line	:	2916 CALLE DERECHA
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-6530
Country	:	US
Telephone Number	:	505-471-0038
Fax Number	:

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

Provider Enumeration Date	:	08/25/2008
Last Update Date	:	08/25/2008

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