Healthcare Provider Details

I. General information

NPI: 1174699557
Provider Name (Legal Business Name): JORGE A RIOS MT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE MATIAS BRUGMAN #98 LABORATORIO CLINICO RIOS LISOJO
LAS MARIAS PR
00670-0000
US

IV. Provider business mailing address

CALLE MATIAS BRUGMAN #98 BOX 50
LAS MARIAS PR
00670-0000
US

V. Phone/Fax

Practice location:
  • Phone: 787-827-4535
  • Fax: 787-827-4535
Mailing address:
  • Phone: 787-827-4535
  • Fax: 787-827-4535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number2070
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: