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General NPI Number Information
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NPI Number | 1154483550
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Entity Type | Individual
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Provider Name | MARTHA EUGENIA DE LOS RIOS
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Gender | Female
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 10/13/2015
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Provider Practice Location Address
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Address Line | 3433 ARDEN WAY
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City | SACRAMENTO
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State | CA
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Zip | 95825-2018
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Country | US
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Telephone | 916-984-4224
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Fax |
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Provider Business Mailing Address
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Address Line | 866 SPOTTED PONY LN
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City | ROCKLIN
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State | CA
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Zip | 95765-5467
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Country | US
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Telephone | 916-960-8454
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 53781
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License Number State | CA
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