Healthcare Provider Details

I. General information

NPI: 1760289235
Provider Name (Legal Business Name): JASMINE TERESA RIOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 E 57TH ST # 104
CHICAGO IL
60637-1455
US

IV. Provider business mailing address

3509 N OPAL AVE
CHICAGO IL
60634-3029
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-1937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number125087760
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: