Healthcare Provider Details

I. General information

NPI: 1629732664
Provider Name (Legal Business Name): GLORISEL RIOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

571 BELLEVUE RD
ATWATER CA
95301-2928
US

IV. Provider business mailing address

571 BELLEVUE RD
ATWATER CA
95301-2928
US

V. Phone/Fax

Practice location:
  • Phone: 209-358-6306
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberTCH70931
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: