Healthcare Provider Details

I. General information

NPI: 1619530391
Provider Name (Legal Business Name): LUCINDA RIOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 GONZALES RD SW
ALBUQUERQUE NM
87121-2401
US

IV. Provider business mailing address

PO BOX 912678
DENVER CO
80291-2678
US

V. Phone/Fax

Practice location:
  • Phone: 505-831-2534
  • Fax:
Mailing address:
  • Phone: 505-241-5182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2023-0632
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: