Healthcare Provider Details

I. General information

NPI: 1730310087
Provider Name (Legal Business Name): JEANNETTE MARIA RIOS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 08/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4308 ALTON RD SUITE 860
MIAMI BEACH FL
33140-4556
US

IV. Provider business mailing address

7911 SW 35TH TER
MIAMI FL
33155-3442
US

V. Phone/Fax

Practice location:
  • Phone: 305-604-2888
  • Fax: 305-604-2887
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS 10730
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: