Healthcare Provider Details

I. General information

NPI: 1255258794
Provider Name (Legal Business Name): JACQUELINE ADRIANA RIOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 STUDEBAKER RD APT 126
NORWALK CA
90650-2250
US

IV. Provider business mailing address

12301 STUDEBAKER RD APT 126
NORWALK CA
90650-2250
US

V. Phone/Fax

Practice location:
  • Phone: 310-766-0327
  • Fax:
Mailing address:
  • Phone: 310-766-0327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number10501
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: