Healthcare Provider Details

I. General information

NPI: 1417495052
Provider Name (Legal Business Name): MARY ALICE RIOS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2577 MAIN AVE
DURANGO CO
81301-5919
US

IV. Provider business mailing address

2577 MAIN AVE
DURANGO CO
81301-5919
US

V. Phone/Fax

Practice location:
  • Phone: 970-505-2100
  • Fax:
Mailing address:
  • Phone: 970-505-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License NumberPA11053
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0008295
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2025-0131
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: