=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164899167
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUIS HERNAN PAZ RIOS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2015
-----------------------------------------------------
Last Update Date | 09/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 399 9TH ST N STE 300
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34102-5820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-624-4200
-----------------------------------------------------
Fax | 239-624-4241
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 399 9TH ST N STE 300
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34102-5820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-624-4200
-----------------------------------------------------
Fax | 239-624-4241
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0011X
-----------------------------------------------------
Taxonomy Name | Interventional Cardiology Physician
-----------------------------------------------------
License Number | ME162086
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RI0011X
-----------------------------------------------------
Taxonomy Name | Interventional Cardiology Physician
-----------------------------------------------------
License Number | 286695
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------