Healthcare Provider Details

I. General information

NPI: 1518966126
Provider Name (Legal Business Name): JUAN FRANCISCO RIOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E DIXIE AVE
LEESBURG FL
34748-5925
US

IV. Provider business mailing address

PO BOX 100183
GAINESVILLE FL
32610-0183
US

V. Phone/Fax

Practice location:
  • Phone: 352-392-0140
  • Fax: 352-392-8217
Mailing address:
  • Phone: 352-392-0140
  • Fax: 352-392-8217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME56342
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: