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General NPI Number Information
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NPI Number | 1548164353
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Entity Type | Individual
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Provider Name | IVANNA NICOLE RIOS MANRIQUEZ DDS
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Gender | Female
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Dates
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Enumeration Date | 10/05/2026
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Last Update Date | 10/05/2026
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Provider Practice Location Address
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Address Line | 42505 WASHINGTON ST STE 101
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City | PALM DESERT
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State | CA
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Zip | 92211-8835
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Country | US
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Telephone | 760-342-4341
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Fax |
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Provider Business Mailing Address
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Address Line | 482 W SAN YSIDRO BLVD STE 1030
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City | SAN YSIDRO
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State | CA
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Zip | 92173-2444
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Country | US
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Telephone | 442-370-4785
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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 | 112988
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License Number State | CA
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