Healthcare Provider Details

I. General information

NPI: 1619298155
Provider Name (Legal Business Name): RODRIGO RIOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RODRIGO RIOS IV MD

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 WABASHA ST S
SAINT PAUL MN
55107-1805
US

IV. Provider business mailing address

2530 CHICAGO AVE
MINNEAPOLIS MN
55404-4289
US

V. Phone/Fax

Practice location:
  • Phone: 952-967-5584
  • Fax:
Mailing address:
  • Phone: 612-813-8800
  • Fax: 612-813-8825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number60580
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number62099
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: