Healthcare Provider Details

I. General information

NPI: 1821216516
Provider Name (Legal Business Name): MS. ELSA RIOS III
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5723 WHITTIER BLVD
LOS ANGELES CA
90022-4222
US

IV. Provider business mailing address

1883 W 23RD ST
LOS ANGELES CA
90018-2105
US

V. Phone/Fax

Practice location:
  • Phone: 323-728-0100
  • Fax:
Mailing address:
  • Phone: 323-732-0371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: