Healthcare Provider Details

I. General information

NPI: 1174490627
Provider Name (Legal Business Name): MIREYA RIOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 10/20/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73345 CA-111 S STE 204
PALM DESERT CA
92260
US

IV. Provider business mailing address

9095 RIO SAN DIEGO DR STE 410
SAN DIEGO CA
92108-1679
US

V. Phone/Fax

Practice location:
  • Phone: 858-326-0890
  • Fax:
Mailing address:
  • Phone: 858-412-6080
  • Fax: 858-412-6376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number78745
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: