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General NPI Number Information
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NPI Number | 1295235984
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Entity Type | Individual
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Provider Name | JON ALVIN RIEGO DE DIOS MODESTO RN
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Gender | Male
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Dates
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Enumeration Date | 02/19/2018
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Last Update Date | 07/16/2026
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Provider Practice Location Address
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Address Line | 746 AVENUE D
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City | DANVILLE
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State | PA
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Zip | 17821-7635
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Country | US
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Telephone | 928-209-4048
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Fax |
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Provider Business Mailing Address
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Address Line | 746 AVENUE D
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City | DANVILLE
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State | PA
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Zip | 17821-7635
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Country | US
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Telephone | 928-209-4048
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN-85497
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | RN712916
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN2320628
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 884244
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN205182
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License Number State | AZ
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Taxonomy #6
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95118046
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License Number State | CA
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Taxonomy #7
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | SP036426
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License Number State | PA
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