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General NPI Number Information
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NPI Number | 1518734722
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Entity Type | Individual
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Provider Name | MELISSA RIOS CSFA
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Gender | Female
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Dates
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Enumeration Date | 12/07/2023
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 2855 E MAGIC VIEW DR
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City | MERIDIAN
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State | ID
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Zip | 83642-6245
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Country | US
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Telephone | 208-639-4862
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Fax |
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Provider Business Mailing Address
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Address Line | 22533 HANLEY DR
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City | WILDER
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State | ID
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Zip | 83676-5826
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Country | US
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Telephone | 208-989-5178
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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 | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number |
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License Number State |
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