Healthcare Provider Details

I. General information

NPI: 1538802905
Provider Name (Legal Business Name): DIEGO MARCIAL RIOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 BANCROFT AVE STE 125B
OAKLAND CA
94605-2456
US

IV. Provider business mailing address

7200 BANCROFT AVE STE 125B
OAKLAND CA
94605-2456
US

V. Phone/Fax

Practice location:
  • Phone: 510-777-4256
  • Fax: 510-777-4244
Mailing address:
  • Phone: 510-777-4256
  • Fax: 510-777-4244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: