Healthcare Provider Details

I. General information

NPI: 1033554936
Provider Name (Legal Business Name): NICOLAS EDUARDO RIOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 10/28/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 S J ST, TACOMA, WA
TACOMA WA
98405
US

IV. Provider business mailing address

PO BOX 84021
SEATTLE WA
98124-8421
US

V. Phone/Fax

Practice location:
  • Phone: 253-426-4101
  • Fax:
Mailing address:
  • Phone: 425-407-1000
  • Fax: 425-407-1112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberQ9498
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD61044292
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: