Healthcare Provider Details

I. General information

NPI: 1427719327
Provider Name (Legal Business Name): ALYSSA RIOS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 S CLARK ST FL 11
CHICAGO IL
60603-1882
US

IV. Provider business mailing address

20 S CLARK ST FL 11
CHICAGO IL
60603-1882
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-3627
  • Fax: 312-357-2284
Mailing address:
  • Phone: 312-926-3627
  • Fax: 312-357-2284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085009798
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: