Healthcare Provider Details

I. General information

NPI: 1871449314
Provider Name (Legal Business Name): EDMUNDO RIOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

465 WALLACE RD
ANTHONY NM
88021-8404
US

IV. Provider business mailing address

465 WALLACE RD
ANTHONY NM
88021-8404
US

V. Phone/Fax

Practice location:
  • Phone: 915-253-4135
  • Fax:
Mailing address:
  • Phone: 915-253-4135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: