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General NPI Number Information
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NPI Number | 1629879721
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Entity Type | Organization
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Legal Business Name | RADIANT MIND NEURO AND PSYCHOLOGY CLINIC INC
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Dates
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Enumeration Date | 03/24/2025
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 402 W BROADWAY STE 400
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City | SAN DIEGO
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State | CA
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Zip | 92101-3554
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Country | US
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Telephone | 619-595-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 3225 MCLEOD DR STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89121-2257
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Country | US
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Telephone | 424-248-7139
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELISSA RIOS
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Credential | PSY.D
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Telephone | 424-248-7139
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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