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General NPI Number Information
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NPI Number | 1063723013
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Entity Type | Individual
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Provider Name | MS. GRACIE QUIROGA RIOS
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Gender | Female
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Dates
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Enumeration Date | 06/24/2010
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 3200 MOTOR AVE
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City | LOS ANGELES
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State | CA
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Zip | 90034-3710
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Country | US
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Telephone | 310-836-1223
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Fax | 310-837-6647
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Provider Business Mailing Address
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Address Line | 3815 FLORAL DR
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City | LOS ANGELES
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State | CA
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Zip | 90063-1717
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Country | US
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Telephone | 213-215-3389
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State | CA
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