Healthcare Provider Details

I. General information

NPI: 1558084442
Provider Name (Legal Business Name): JUSTO EDUARDO RIOS SR. PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 CALLE MERCEDES MORENO
AGUADILLA PR
00603-5152
US

IV. Provider business mailing address

PO BOX 650
AIBONITO PR
00705-0650
US

V. Phone/Fax

Practice location:
  • Phone: 787-882-6370
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number023743
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: