Healthcare Provider Details

I. General information

NPI: 1720641095
Provider Name (Legal Business Name): CARLOS GUILLERMO RIOS ND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2019
Last Update Date: 03/25/2023
Certification Date: 03/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4895 CAPITOLA RD
CAPITOLA CA
95010-3810
US

IV. Provider business mailing address

4895 CAPITOLA RD
CAPITOLA CA
95010-3810
US

V. Phone/Fax

Practice location:
  • Phone: 831-426-4343
  • Fax: 831-476-7781
Mailing address:
  • Phone: 831-426-4343
  • Fax: 831-476-7781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND1071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: