Healthcare Provider Details

I. General information

NPI: 1942267695
Provider Name (Legal Business Name): EDUARDO A. RIOS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 CALLE ANTONIO LOPEZ
TOA ALTA PR
00953
US

IV. Provider business mailing address

PO BOX 902
TOA ALTA PR
00954-0902
US

V. Phone/Fax

Practice location:
  • Phone: 787-870-3760
  • Fax:
Mailing address:
  • Phone: 787-870-3760
  • Fax: 787-870-2735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number0634
License Number StatePR

VIII. Authorized Official

Name: EDUARDO ALFONSO RIOS
Title or Position: MD
Credential:
Phone: 787-870-3760