Healthcare Provider Details

I. General information

NPI: 1245146455
Provider Name (Legal Business Name): JAMES RIOS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1327 S SAN GABRIEL BLVD
SAN GABRIEL CA
91776-3601
US

IV. Provider business mailing address

1110 S MCBRIDE AVE
LOS ANGELES CA
90022-2918
US

V. Phone/Fax

Practice location:
  • Phone: 626-573-2453
  • Fax:
Mailing address:
  • Phone: 323-317-7132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: