Healthcare Provider Details

I. General information

NPI: 1003388687
Provider Name (Legal Business Name): JOHNATHAN X RIOS AAC, CHW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2018
Last Update Date: 12/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 JAMES ST
SEATTLE WA
98104-5102
US

IV. Provider business mailing address

216 JAMES ST
SEATTLE WA
98104-5102
US

V. Phone/Fax

Practice location:
  • Phone: 206-464-6454
  • Fax: 206-652-1236
Mailing address:
  • Phone: 206-464-6454
  • Fax: 206-652-1236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCG60915191
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: