Healthcare Provider Details

I. General information

NPI: 1518700939
Provider Name (Legal Business Name): ALEXANDRA RIOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2024
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

2100 W 3RD ST STE 400
LOS ANGELES CA
90057-2290
US

V. Phone/Fax

Practice location:
  • Phone: 323-660-2450
  • Fax:
Mailing address:
  • Phone: 888-499-9303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number95137999
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95035167
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: