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General NPI Number Information
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NPI Number | 1841702990
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Entity Type | Individual
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Provider Name | MR. SERGIO RIOS
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Gender | Male
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Dates
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Enumeration Date | 10/30/2017
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Last Update Date | 06/15/2018
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Provider Practice Location Address
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Address Line | 5979 NW 151ST ST STE 102I
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City | MIAMI LAKES
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State | FL
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Zip | 33014
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Country | US
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Telephone | 786-953-5120
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Fax |
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Provider Business Mailing Address
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Address Line | 1630 W 46TH ST APT 310
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City | HIALEAH
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State | FL
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Zip | 33012-2814
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Country | US
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Telephone | 786-333-0125
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Fax | 305-907-5322
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State | FL
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