Healthcare Provider Details

I. General information

NPI: 1497455810
Provider Name (Legal Business Name): NELSON OMAR RIOS NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 11/02/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W COLE BLVD
CALEXICO CA
92231-9700
US

IV. Provider business mailing address

1180 N INDIAN CANYON DR STE 420
PALM SPRINGS CA
92262-4859
US

V. Phone/Fax

Practice location:
  • Phone: 912-251-2567
  • Fax:
Mailing address:
  • Phone: 760-778-7147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95024493
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: